bluuebunny/crossref_metadata_2025 huggingface dataset:
Sand patterns: distributed agency and the idea of ‘working with nature’ in coastal environments
Authors: Buitendijk Tomas
Published: April 2024

In this article, I examine the concept of shared or ‘distributed’ agency between humans and non-humans in the context of coastal environments. Drawing on critical theory from the environmental humanities and cultural geography, I begin by situating distributed agency within a relational paradigm for human existence in a more-than-human world, building on the idea of receptivity to bridge the gap between an ontological and a moral-political understanding of the other-than-human capacity to act. I subsequently bring the concept of distributed agency into dialogue with the idea of ‘working with nature’, notably examples of the ‘sand motor’ coastal landscape intervention found in the Netherlands, United Kingdom, and Ireland. The sand motor is a method for beach nourishment that operates on the basis of autonomous sediment dispersal, and that is meant to replace existing approaches to coastal protection that are labor-intensive and have a much shorter lifespan. Using the different cases, I demonstrate how planned and accidental deployments of the sand motor can be tied to varying paradigms for human/nature relationships, which may either contradict or support the principles of distributed agency. With regard to the latter, I highlight the importance of agential indeterminacy and human accountability for the long-term sustainability of pluriagential collaborations. Ultimately, by engaging productively with other-than-human expressions of agency through an ongoing practice of receptivity, important steps can be taken toward a more resilient future for all.
High-flow carotid cavernous fistula and ‘white eye’: A rare and easily misdiagnosed presentation – A case report and literature review
Authors: Caiza-Zambrano Francisco , Gómez Lastra Martín , Garbugino Silvia , Gonzalez Fabio Maximiliano , Galarza Menoscal Julio , Benetti Mauricio , Neme Segura Yemina , Miquelini Luis Ariel , Uribe-Roca Claudia , Fernández-Pardal Manuel , León-Cejas Luciana , Reisin Ricardo , Bonardo Pablo
Published: April 2024

The three classic symptoms of carotid cavernous fistula (CCF) are pulsating exophthalmos, bruit and conjunctival chemosis. Here, we present a clinical case of isolated abducens nerve palsy due to a high-flow CCF in an 84-year-old woman, without the typical congestive orbito-ocular features. It was a diagnostic challenge because, for patients older than 50 years with cardiovascular risk factors, ischaemic mononeuropathy is the most frequent aetiology. This case illustrates the least common type of CCF that can be easily misdiagnosed. Physicians should consider fistula as a possible diagnosis in a patient with isolated abducens nerve palsy even without the classic triad.
Assessing an Instructional Level During Reading Fluency Interventions: A Meta-Analysis of the Effects on Reading
Authors: Burns Matthew K.
Published: April 2024

The current study meta-analyzed 27 effects from 21 studies to determine the effect assessment of text difficulty had on reading fluency interventions, which resulted in an overall weighted effect size ( ES) = 0.43 (95% CI = [0.25, 0.62], p < .001). Using reading passages that represented an instructional level based on accuracy criteria led to a large weighted effect of ES = 1.03, 95% CI = [0.65, 1.40], p < .01), which was reliably larger ( p < .05) than that for reading fluency interventions that used reading passages with an instructional level based on rate criteria (weighted ES = 0.29, 95% CI = [0.07, 0.50], p < .01). Using reading passages based on leveling systems or those written at the students’ current grade level resulted in small weighted effects. The approach to determining difficulty for reading passages used in reading fluency interventions accounted for 11% of the variance in the effect ( p < .05) beyond student group (no risk, at-risk, disability) and type of fluency intervention. The largest weighted effect was found for students with reading disabilities ( ES = 1.14, 95% CI = [0.64, 1.65], p < .01).
The Role of Artificial Intelligence in Medical Education: A Systematic Review
Authors: Tozsin Atinc , Ucmak Harun , Soyturk Selim , Aydin Abdullatif , Gozen Ali Serdar , Fahim Maha Al , Güven Selcuk , Ahmed Kamran
Published: April 2024

Background

To examine the artificial intelligence (AI) tools currently being studied in modern medical education, and critically evaluate the level of validation and the quality of evidence presented in each individual study.

Methods

This review (PROSPERO ID: CRD42023410752) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A database search was conducted using PubMed, Embase, and Cochrane Library. Articles written in the English language between 2000 and March 2023 were reviewed retrospectively using the MeSH Terms “AI” and “medical education” A total of 4642 potentially relevant studies were found.

Results

After a thorough screening process, 36 studies were included in the final analysis. These studies consisted of 26 quantitative studies and 10 studies investigated the development and validation of AI tools. When examining the results of studies in which Support vector machines (SVMs) were employed, it has demonstrated high accuracy in assessing students’ experiences, diagnosing acute abdominal pain, classifying skilled and novice participants, and evaluating surgical training levels. Particularly in the comparison of surgical skill levels, it has achieved an accuracy rate of over 92%.

Conclusion

AI tools demonstrated effectiveness in improving practical skills, diagnosing diseases, and evaluating student performance. However, further research with rigorous validation is required to identify the most effective AI tools for medical education.
Impact of Intermittent Intraoperative Neuromonitoring (IONM) on the Learning Curve for Total Thyroidectomy by Residents in General Surgery
Authors: Fassari Alessia , Micalizzi Alessandra , Lelli Giulio , Gurrado Angela , Polistena Andrea , Iossa Angelo , De Angelis Francesco , Martini Lorenzo , Tamagnini Giovanni Traumuller , Testini Mario , Cavallaro Giuseppe
Published: April 2024

Introduction

Recurrent laryngeal nerve (RNL) identification constitutes the standard in thyroidectomy. Intraoperative nerve monitoring (IONM) has been introduced as a complementary tool for RLN functionality evaluation. The aim of this study is to establish how routine use of IONM can affect the learning curve (LC) in thyroidectomy.

Methods

Patients undergoing total thyroidectomy performed by surgery residents in their learning curve course in 2 academic hospitals, were divided into 2 groups: Group A, including 150 thyroidectomies performed without IONM by 3 different residents, and Group B, including 150 procedures with routine use of intermittent IONM, by other 3 different residents. LC was measured by comparing operative time (OT), its stabilization during the development of the LC, perioperative complication rate.

Results

As previously demonstrated, the LC was achieved after 30 procedures, in both groups, with no differences due to the use of IONM. Similarly, there were no significant differences among the 2 groups, and between subgroups independently matched, for both OT and complications, even when comparing RLN palsy. Direct nerve visualization and IONM assessment rates were comparable in all groups, and no bilateral RLN palsy (transient or permanent) were reported. No case of interrupted procedure to unilateral lobectomy, due to evidence of RLN injury, was reported.

Conclusions

The study demonstrates that the use of IONM thyroid surgery, despite requiring a specific training with experienced surgeons, does not particularly affect the learning curve of residents approaching this kind of surgery, and for this reason its routine use should be encouraged even for trainees.
Doing Fieldwork Among Hard-To-Reach Populations: An Account of Local Female Researchers Studying Foreign Migrants in Downtown Bloemfontein, South Africa
Authors: Ramogwebo Theodorah , Hlongwane Jeniffer Shalati , Bhanye Johannes , Matamanda Abraham
Published: April 2024

Fieldwork challenges involving hard-to-reach populations and with which many novice researchers grapple are apparent. However, literature on the issues related to female researchers’ experiences with hard-to-reach populations like undocumented foreign migrants is scarce. This article reflects on local female researchers’ fieldwork experiences during a study on the socio-economic impacts of the COVID-19 pandemic on foreign migrants operating informal businesses in the downtown area of Bloemfontein, South Africa. Our findings highlight unique challenges confronted by local female researchers compared to their male counterparts, including the risk of physical and emotional harm. Despite these challenges, female researchers play a vital role in accessing and understanding hard-to-reach populations, contributing immensely to the fieldwork research process. We also recognize the influence of contextual factors, such as xenophobia, on fieldwork dynamics, emphasizing the need to consider broader socio-political factors during fieldwork. To foster more inclusive research practices, we advocate for the involvement of members from hard-to-reach populations as integral members of the research team, offering their invaluable insider perspectives, knowledge and cultural milieu. Looking ahead, we call for greater support for women in research, including gender-sensitive training, and increased awareness of gender-based risks during fieldwork.
An explicit solution of forward and inverse kinematics for a serial manipulator with insufficient intersection joints based on finite and instantaneous screw theory
Authors: Qi Yang , Zhang Sen , Ren Xiaofei , Tong Xinran , Liang Dong , Han Lin
Published: April 2024

To satisfy the requirements of large workspace, high capability, and low inertia demanded by the high precision and high stiffness aerospace equipment, serial manipulator with insufficient intersection joints is proposed in this article based on finite and instantaneous screw theory. Due to the specific topology structure with no intersecting joints at both ends, the explicit solution of forward and inverse kinematics for the serial manipulator with insufficient intersection joints proposed in this article is extremely difficult. Therefore, an analytical method based on finite and instantaneous screw theory is proposed for this serial manipulator, and the explicit kinematic solution is derived in this article. According to particular calculation principle of finite and instantaneous screw theory, the finite motion of this serial manipulator is described. Based on this description, the product of exponentials formula of the kinematics of the serial manipulator with insufficient intersection joints is established on the basic of finite and instantaneous screw theory for the first time, and a novel subproblem is arose during the decomposition of product of exponentials formula. Regarding this issue, an innovative approach to this subproblem is proposed by introducing the new Paden–Kahan subproblem with elimination, and the explicit solution for the inverse kinematics is derived. Finally, the numerical examples are simulated, and the correctness of the method proposed in this article is verified.
The regulation of the PD-1/PD-L1 pathway in imiquimod-induced chronic psoriasis itch and itch sensitization in mouse
Authors: Xu Zhehao , Wang Yue , Jiang Changcheng , Wang Zhengwei , Cheng YongFeng , Fan Manli
Published: April 2024

PD-1/PD-L1 inhibitors have been demonstrated to induce itch in both humans and experimental animals. However, whether the PD-1/PD-L1 pathway is involved in the regulation of chronic psoriatic itch remains unclear. This study aimed to investigate the role of the PD-1/PD-L1 pathway in imiquimod-induced chronic psoriatic itch. The intradermal injection of PD-L1 in the nape of neck significantly alleviated chronic psoriatic itch in imiquimod-treated skin. Additionally, we observed that spontaneous scratching behavior induced by imiquimod disappeared on day 21. Still, intradermal injection of PD-1/PD-L1 inhibitors could induce more spontaneous scratching for over a month, indicating that imiquimod-treated skin remained in an itch sensitization state after the spontaneous scratching behavior disappeared. During this period, there was a significant increase in PD-1 receptor expression in both the imiquimod-treated skin and the spinal dorsal horn in mice, accompanied by significant activation of microglia in the spinal dorsal horn. These findings suggest the potential involvement of the peripheral and central PD-1/PD-L1 pathways in regulating chronic itch and itch sensitization induced by imiquimod.
Concomitant use of pre-emptive analgesia with local and general anesthesia in rat uterine pain surgical model
Authors: Mumtaz Saima , Baseer Najma , Habib Syed Hamid
Published: April 2024

Preemptive analgesia is used for postoperative pain management, providing pain relief with few adverse effects. In this study, the effect of a preemptive regime on rat behavior and c-fos expression in the spinal cord of the uterine surgical pain model was evaluated. It was a lab-based experimental study in which 60 female Sprague-Dawley rats; eight to 10 weeks old, weighing 150–300 gm were used. The rats were divided into two main groups: (i) superficial pain group (SG) (with skin incision only), (ii) deep pain group (with skin and uterine incisions). Each group was further divided into three subgroups based on the type of preemptive analgesia administered i.e., “tramadol, buprenorphine, and saline subgroups.” Pain behavior was evaluated using the “Rat Grimace Scale” (RGS) at 2, 4, 6, 9 and 24 h post-surgery. Additionally, c-fos immunohistochemistry was performed on sections from spinal dorsal horn (T12-L2), and its expression was evaluated using optical density and mean cell count 2 hours postoperatively. Significant reduction in the RGS was noted in both the superficial and deep pain groups within the tramadol and buprenorphine subgroups when compared to the saline subgroup ( p ≤ .05). There was a significant decrease in c-fos expression both in terms of number of c-fos positive cells and the optical density across the superficial laminae and lamina X of the spinal dorsal horn in both SD and DG ( p ≤ .05). In contrast, the saline group exhibited c-fos expression primarily in laminae I-II and III-IV for both superficial and deep pain groups and lamina X in the deep pain group only ( p ≤ .05). Hence, a preemptive regimen results in significant suppression of both superficial and deep components of pain transmission. These findings provide compelling evidence of the analgesic efficacy of preemptive treatment in alleviating pain response associated with uterine surgery.
New Insights on Expert Opinion About Eyewitness Memory Research
Authors: Seale-Carlisle Travis M. , Quigley-McBride Adele , Teitcher Jennifer E. F. , Crozier William E. , Dodson Chad S. , Garrett Brandon L.
Published: April 2024

Experimental psychologists investigating eyewitness memory have periodically gathered their thoughts on a variety of eyewitness memory phenomena. Courts and other stakeholders of eyewitness research rely on the expert opinions reflected in these surveys to make informed decisions. However, the last survey of this sort was published more than 20 years ago, and the science of eyewitness memory has developed since that time. Stakeholders need a current database of expert opinions to make informed decisions. In this article, we provide that update. We surveyed 76 scientists for their opinions on eyewitness memory phenomena. We compared these current expert opinions to expert opinions from the past several decades. We found that experts today share many of the same opinions as experts in the past and have more nuanced thoughts about two issues. Experts in the past endorsed the idea that confidence is weakly related to accuracy, but experts today acknowledge the potential diagnostic value of initial confidence collected from a properly administered lineup. In addition, experts in the past may have favored sequential over simultaneous lineup presentation, but experts today are divided on this issue. We believe this new survey will prove useful to the court and to other stakeholders of eyewitness research.
How coaches’ decision-making affects athlete selection: A systematic review and meta-synthesis
Authors: Xiang Changqing , Zhao Jie , Tengku Kamalden Tengku Fadilah , Dong Wenting , Luo Hua , Ismail Normala
Published: April 2024

Athlete selection, as a crucial step for the success of competitive sports, is the last hurdle in the whole sports talent cultivation chain, which is related to the stability and sustainable development of the sports. In athlete selection, coaches play the role of decision-makers in selecting the most suitable athletes for a specific sport or competition from a large pool of talented athletes. Therefore, understanding how coaches’ decisions impact athlete selection is crucial in establishing selection rules, formulating effective decision-making, and developing accurate athlete development policies. This review was conducted by searching the Web of Science, PubMed, Scopus, and SPORTDiscus databases for English-language literature on coaching decision-making and talent selection, and screening and categorizing the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 10 articles were included in this review. Based on the meta-synthesis findings, coaches’ decision-making styles, intuition, and abilities play a significant role in athlete selection. Additionally, coaches’ personalities are also an important factor that influences their decision-making process in identifying and selecting talented players. This review also emphasizes that coach decision-making is essential not only in athlete selection, but also in athlete detection, identification, and development, as coach behavior affects the success of the entire team. In addition, reinforcement of professional competence development and maintenance of continuous learning for coaches is the requirement of the times and the key to the success of athlete selection.
Navigating uncharted territory: a case report and literature review on the remarkable response to personalized crizotinib containing combinational therapy in a pazopanib refractory patient with novel alterations
Authors: Aydın Esranur , Tokat Ünal Metin , Özgü Eylül , Adibi Ashkan , Tutar Onur , Kurzrock Razelle , Demiray Mutlu
Published: April 2024

This paper presents a patient with a novel Ig-like-III domain fibroblast growth factor receptor (FGFR2) alteration (W290_P307>C) along with CDKN2A/B alterations and a cadherin 1 (CDH1) alteration. Initial responsiveness to pazopanib monotherapy was encouraging, yet progression occurred after 7.5 months. Following progression, the molecular tumor board recommended a combination therapy approach comprising pazopanib, crizotinib, and palbociclib to target all of the changed pathways at the same time. Pazopanib was chosen to specifically target the FGFR2 alteration, while crizotinib was selected due to its potential synthetic lethality with the CDH1 alteration. In addition, the CDK4/6 inhibitor palbociclib was administered to address the CDKN2A/B alterations. The patient exhibited a remarkable and sustained response to this innovative combination. This case not only underscores the potential of tyrosine kinase inhibitors, exemplified by pazopanib, as a viable alternative for patients without access to pan-FGFR inhibitors, but it also emphasizes their efficacy beyond commonly detected point mutations and rearrangements. Notably, the outstanding response to combination therapy, including crizotinib, in a patient with a CDH1 alteration, further substantiates the preclinical evidence of synthetic lethality between crizotinib and CDH1 alterations. To our knowledge, this represents the first clinical evidence demonstrating the efficacy of crizotinib in a patient with a CDH1 alteration. Through careful dosage adjustments and consideration of individualized genomic information, this case exemplifies the power of personalized medicine in achieving favorable treatment outcomes.
Fatigue Affects Body Acceleration During Vertical Jumping and Agility Tasks in Elite Young Badminton Players
Authors: Cheng Kai-Chia , Chiu Ya-Lan , Tsai Chia-Liang , Hsu Yu-Liang , Tsai Yi-Ju
Published: April 2024

Background:

Badminton is a sport demanding both high aerobic and anaerobic fitness levels, and fatigue can significantly impact game performance. However, relevant studies are limited, and none have employed a wearable inertial measurement unit (IMU) to investigate the effects of fatigue on athletic performance in the field.

Hypothesis:

Overall performance and body acceleration in both time and frequency domains during the fundamental badminton skills of vertical jumping and changes of direction will be affected by fatigue.

Study Design:

Cross-sectional study.

Level of Evidence:

Level 3.

Methods:

A total of 38 young badminton players competing at the Division I level participated. Body accelerations while performing vertical jump and agility-T tests before and immediately after undergoing a fatigue protocol were measured by an IMU, positioned at the L4 to L5 level.

Results:

Jumping height decreased significantly by 4 cm ( P < 0.01) after fatigue with greater downward acceleration (1.03 m/s2, P < 0.05) during the squatting subphase. Finishing time increased significantly by 50 ms only during the 10-m side-shuffling of the agility-T test ( P = 0.02) after fatigue with greater peak and mean accelerations (3.83 m/s2, P = 0.04; 0.43 m/s2, P < 0.01), and higher median and mean frequency (0.38 Hz, P = 0.04, 0.11 Hz, P = 0.01).

Conclusion:

This study using a wearable IMU demonstrates the effects of fatigue on body acceleration in badminton players. The frequency-domain analysis further indicated that fatigue might lead to loss of voluntary control of active muscles and increased impacts on the passive elastic elements.

Clinical Relevance:

The findings imply that fatigue can lead to diminished athletic performance and highlight the potential for an increased risk of sports injuries. Consequently, maintaining precision in monitoring fatigue is crucial for elite young badminton players.
Appropriateness of magnetic resonance imaging of the lumbar spine orders for low back pain in a general hospital
Authors: Lee Weiyong , Salkade Parag Ratnakar , Tang Phua Hwee
Published: April 2024

Introduction

Inappropriate magnetic resonance imaging (MRI) for low back pain contributes to increased healthcare costs. The American College of Radiology (ACR) appropriateness criteria for low back pain is a guideline to reduce these unnecessary MRIs.

Methods

Retrospective study of the MRI lumbar spine performed for the investigation of low back pain in a General Hospital from 2016-2017. Divided into six clinical categories. (1) No Red Flags. (2) Low-velocity trauma, osteoporosis, elderly individuals, or chronic steroid use. (3) Suspicion of cancer, infection, or immunosuppression. (4) Failed conservative management. (5) Prior lumbar surgery. (6) Suspected cauda equina syndrome or neurological deficit. MRI findings are divided into 1) Critical findings of spinal cord/cauda equina compression, metastatic cancer, spinal epidural abscess, and vertebral osteomyelitis. 2) Significant findings of vertebral compression fracture or compression of the lumbar spinal nerves. 3) Non-specific findings with no compression of the lumbar spinal nerves and no critical findings.

Results

670 MRI lumbar spine were performed. 25.3% in group (1) with 0% critical findings. 35.3% in group (2) with 4.6% critical findings. 5.8% in group (3) with 39.5% critical findings. 23.4% in group (4) with 0% critical findings. 2.8% in in group (5) with 0% critical findings. 7.3% in group (6) with 91.7% critical findings.

Conclusion

25.3% of MRI lumbar spine performed were inappropriate based on the ACR criteria. Moreover, there were no critical findings in this group. The use of ACR appropriateness criteria can reduce unnecessary MRI lumbar spine for low back pain without compromising patient safety.
Untimely surgery for stent-fracture-related death after transjugular intrahepatic portosystemic shunt: a case report
Authors: Li Yunjiang , Sun Junhui , Zhou Tanyang , Wang Weiwei , Wang Guowei , Hou Qingming , Chen Zuhua , Wang Qiang , Xu Keyang , Ye Yunfeng , Bao Jianfeng
Published: April 2024

Transjugular intrahepatic portosystemic shunt (TIPS) is a life-saving procedure for patients with severe portal hypertension and persistent variceal bleeding. Stent fracture is a rare and severe complication; however, its cause and mechanisms remain poorly defined. This case helps understand the factors contributing to its occurrence, complications, and subsequent poor outcomes. A 63-year-old male was presented with ruptured bare stent after a TIPS procedure. The upper edge of the bare stent was ruptured, and its fraction subsequently migrated to the entrance of the right atrium. Meanwhile, a mural thrombus was formed in the inferior vena cava. A surgery for the removal of free fracture was planned for preventing the form of pulmonary embolism. Before the surgery, the fracture was shifted to the right inferior pulmonary artery. Therefore, the surgery was canceled for further evaluation. Then, hematemesis suddenly occurred with a high possibility of variceal bleeding and/or gastric ulcer bleeding. Despite comprehensive treatments, the patient symptoms were still worsened with the development of chest tightness, shortness of breath, severe hypoxia, and heart failure. Finally, the patient succumbed to systemic multiorgan failure and death. Taken together, a ruptured unstable stent should be removed as early as the patient is hemodynamically stable, as it is difficult to balance between hemostasis therapy and anticoagulation treatment in patients with liver-cirrhosis-related severe portal hypertension. Physicians should be on high alert of the potential complications of bare stent rapture after TIPS.
Drug–drug interaction between tacrolimus and caspofungin in Chinese kidney transplant patients with different CYP3A5 genotypes
Authors: Zhang Yundi , Shen Bowen , Li Yue , Zong Huiying , Zhang Xiaoming , Cao Xiaohong , Liu Fengxi , Li Yan
Published: April 2024

Background:

The effect of drug–drug interaction between tacrolimus and caspofungin on the pharmacokinetics of tacrolimus in different CYP3A5 genotypes has not been reported in previous studies.

Objectives:

To investigate the effect of caspofungin on the blood concentration and dose of tacrolimus under different CYP3A5 genotypes.

Design:

We conducted a retrospective cohort study in The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital from January 2015 to December 2022. All kidney transplant patients were divided into the combination or non-combination group based on whether tacrolimus was combined with caspofungin or not. Patients were subdivided into CYP3A5 expressers ( CYP3A5*1/*1 or CYP3A5*1/*3) and CYP3A5 non-expressers ( CYP3A5*3/*3).

Methods:

Data from the combination and the non-combination groups were matched with propensity scores to reduce confounding by SPSS 22.0. A total of 200 kidney transplant patients receiving tacrolimus combined with caspofungin or not were enrolled in this study. Statistical analysis was conducted on the dose-corrected trough concentrations ( C0/ D) and dose requirements ( D) of tacrolimus using independent sample two-sided t-test and nonparametric tests to investigate the impact on patients with different.

Results:

In this study, the C0/ D values of tacrolimus were not significantly different between the combination and non-combination groups ( p = 0.054). For CYP3A5 expressers, there was no significant difference in tacrolimus C0/ D or D values between the combination and non-combination groups ( p = 0.359; p = 0.851). In CYP3A5 nonexpressers, the C0/ D values of tacrolimus were significantly lower in the combination than in the non-combination groups ( p = 0.039), and the required daily dose of tacrolimus was increased by 11.11% in the combination group.

Conclusion:

Co-administration of caspofungin reduced tacrolimus blood levels and elevated the required daily dose of tacrolimus. In CYP3A5 non-expressers, co-administration of caspofungin had a significant effect on tacrolimus C0/ D values. An approximate 10% increase in the weight-adjusted daily dose of tacrolimus in CYP3A5 non-expressers is recommended to ensure the safety of tacrolimus administration.
Epidemiological trends and clinical outcomes of cryptococcosis in a medically insured population in the United States: a claims-based analysis from 2017 to 2019
Authors: Chastain Daniel B. , Zhang Qian , Chen Xianyan , Young Henry N. , Franco-Paredes Carlos , Tuells Jose , Thompson George R. , Henao-Martínez Andrés F.
Published: April 2024

Background:

Emerging risk factors highlight the need for an updated understanding of cryptococcosis in the United States.

Objective:

Describe the epidemiological trends and clinical outcomes of cryptococcosis in three patient groups: people with HIV (PWH), non-HIV-infected and non-transplant (NHNT) patients, and patients with a history of solid organ transplantation.

Methods:

We utilized data from the Merative Medicaid Database to identify individuals aged 18 and above with cryptococcosis based on the International Classification of Diseases, Tenth Revision diagnosis codes from January 2017 to December 2019. Patients were stratified into PWH, NHNT patients, and transplant recipients according to Infectious Diseases Society of America guidelines. Baseline characteristics, types of cryptococcosis, hospitalization details, and in-hospital mortality rates were compared across groups.

Results:

Among 703 patients, 59.7% were PWH, 35.6% were NHNT, and 4.7% were transplant recipients. PWH were more likely to be younger, male, identify as Black, and have fewer comorbidities than patients in the NHNT and transplant groups. Notably, 24% of NHNT patients lacked comorbidities. Central nervous system, pulmonary, and disseminated cryptococcosis were most common overall (60%, 14%, and 11%, respectively). The incidence of cryptococcosis fluctuated throughout the study period. PWH accounted for over 50% of cases from June 2017 to June 2019, but this proportion decreased to 47% from July to December 2019. Among the 52% of patients requiring hospitalization, 61% were PWH and 35% were NHNT patients. PWH had longer hospital stays. In-hospital mortality at 90 days was significantly higher in NHNT patients (22%) compared to PWH (7%) and transplant recipients (0%). One-year mortality remained lowest among PWH (8%) compared to NHNT patients (22%) and transplant recipients (13%).

Conclusion:

In this study, most cases of cryptococcosis were PWH. Interestingly, while the incidence remained relatively stable in PWH, it slightly increased in those without HIV by the end of the study period. Mortality was highest in NHNT patients.
Clinical utility of metagenomic next-generation sequencing in fever of undetermined origin
Authors: Daher Marilyne , Iordanov Roumen , Al Mohajer Mayar , Sohail M. Rizwan , Staggers Kristen Andrews , Hamdi Ahmed Mufeed
Published: April 2024

Background:

Metagenomic next-generation sequencing (mNGS) is a novel diagnostic tool increasingly used in the field of infectious diseases. Little guidance is available regarding its appropriate use in different patient populations and clinical syndromes. We aimed to review the clinical utility of mNGS in patients with a specific clinical syndrome and identify factors that may increase its utility.

Methods:

We retrospectively reviewed charts of 72 non-immunocompromised adults hospitalized with the clinical syndrome of ‘fever of undetermined origin’ and underwent mNGS testing. Standardized criteria from a previously published study were used to determine the clinical impact of mNGS testing. We applied logistic regression to identify factors associated with a positive clinical impact.

Results:

Of the 72 patients identified, 62.5% were males with a median age of 56. All patients had a fever at the time of evaluation. At least one organism was identified in 65.3% of cases; most commonly were Epstein–Barr virus (13.9%), cytomegalovirus (12.5%), and Rickettsia typhi (11.1%). Of those determined to have an infectious etiology of their febrile syndrome, 89.5% ( n = 34/38) had a positive mNGS. Consistency between the organism(s) on mNGS and the clinically determined infectious etiology was 82.4%. mNGS had a positive clinical impact in 40.3% of cases, a negative impact in 2.8%, and no impact in 56.9% of cases. Besides age, we did not identify other factors associated with a higher likelihood of positive clinical impact.

Conclusion:

In our review, mNGS had a positive clinical impact in a large proportion of adults with fever of undetermined origin, with minimal negative impact. However, mNGS results should be interpreted carefully given the high rate of detection of pathogens of unclear clinical significance. Randomized clinical trials are needed to assess the clinical utility of this novel diagnostic tool.
Translating 1 Corinthians 12.31a as a Rhetorical Question
Authors: Jeong Donghyun
Published: April 2024

Understanding ζηλοῦτε in the indicative mood, this paper proposes the following translation of 1 Cor 12.31a: “Yet, are you continuously striving for the ‘greater’ spiritual gifts?” Considering the flow of Paul’s arguments, the indicative reading of ζηλοῦτε should be preferred to the imperative reading that is predominantly found in Bible translations and scholarly discussions. Furthermore, translating this indicative ζηλοῦτε interrogatively (i.e., as Paul asking a rhetorical question)—rather than as a simple statement—can help Bible readers better recognize the rhetorical force of the passage. This paper defends this indicative-interrogative translation by challenging four common objections to the indicative reading of 1 Cor 12.31a.
Demonization of Local Terminology in Bible Translation: The Case of Nat in the Kachin Bible
Authors: Dumdaw Naw Din
Published: April 2024

There are cases in which Bible translation has involved the demonization of local terminology. This is the case with the translation of the Bible into the Kachin language of Myanmar (Burma). The pre-Christian religion of Kachins was Nat worship, which provided religious vocabulary items for the Kachin Bible translation. The local term Nat (meaning “spirit”) was used for several demonological terms in the Kachin Bible. This study argues that the local term Nat was demonized in the process of Bible translation, resulting in a lasting and damaging impact on the biblical and theological understanding of Kachin Christians.
Does Luke Replace “Son of God” with Non-filial Language?
Authors: Doherty David A.
Published: April 2024

In 2005 missiologist Rick Brown argued on the basis of Synoptic parallels that, in a few cases, Luke translates Son of God language with non-filial language, especially the term “Christ.” The argument supported the practice of using non-filial renderings of Son of God language in Bible translations made for Muslims, the stated intent being to convey the meaning of the text more clearly and to avoid offense and misunderstanding. This article tests Brown’s claim, mainly by considering the literary relationships between the Synoptic Gospels and by examining every Lukan parallel of Markan and/or Matthean Son of God language used with reference to Jesus. The results of the investigation contradict Brown’s thesis, showing that the relevant Lukan texts do not provide direct support for the rendering of Son of God language with non-filial language.
A Partial Least Squares Structural Equation Modeling Exploration of EFL Learners’ Perceptions of What Contributes to the Readability of Model Paragraphs
Authors: Nguyen Tuyen Thanh , Baker John R. , Le Thao Quang
Published: April 2024

This study investigated what features undergraduate EFL learners perceive as affecting the difficulty of model paragraphs. Four hundred and seventy-five Vietnamese undergraduates participated in a partial least squares structural equation model design. They ranked five paragraphs from easiest to most difficult and responded to a 10-point Likert questionnaire regarding 11 features (titles, paragraph length, vocabulary, vocabulary in context, rhetorical organization, paragraph structure, sentence length, punctuation, signal words, interest, background knowledge). The results showed that eight variables (titles, vocabulary, vocabulary in context, sentence length, rhetorical organization, paragraph structure, interest, background knowledge) had a significant direct effect and four variables (vocabulary, sentence length, rhetorical organization, background knowledge) had mediating effects. The model accounted for 0.508 R2 of students’ perceptions, with a moderate to high predictive relevance ( Q2 = 0.35). The paper also discusses the results’ implications for those in writing studies and the publishing industry. Suggestions for future study are also presented.
Consumers’ Willingness to Pay for an Increase Fee in Biodegradable Plastic Bag Use in Bandar Baru Bangi, Selangor, Malaysia
Authors: Mohamed Noor Muhamad Faizal Bin , Matthew Nitanan Koshy , Puan Chong Leong
Published: April 2024

Excessive and persistent use of plastic bags has caused severe environmental impact in many developing countries and the significance of biodegradable plastic bags as an alternative solution is uncertain. Bandar Baru Bangi, the second township in the Selangor state in Peninsular Malaysia, has also been plagued with problems of plastic bag use where plastic bags cover 56% of the household waste. Selangor has introduced a plastic bag fee of MYR 0.20 to shoppers who requested for it, albeit the effectiveness of such policy in changing consumer behavior is still unknown. The objectives of the study were to assess consumers’ plastic bags consumption behavior in Bandar Baru Bangi, and determine factors influencing their willingness to pay (WTP) for an increase fee in using biodegradable plastic bags. A questionnaire survey incorporating Contingent Valuation Method was conducted to elicit the consumers’ WTP. The results indicate that majority of the respondents (83%) requested one to three plastic bags per shopping trip. They moderately agreed that their tendency for plastic bag use was influenced by other consumers in the surrounding and highly agreed on the impact of environmental campaigns. The WTP for biodegradable plastic bags was estimated at MYR 0.43 which was influenced by their age and education level. The findings suggest there is a need to revisit the effectiveness of the policy and revise proper intervention measures to reduce plastic bag use.
“There’s Still Time to be Happy”: The Life Trajectories of Portuguese Transgender Women Who Transitioned at 50+ Years
Authors: Carvalho Rita , Tavares João , Casado Tatiana , Sousa Liliana , Guerra Sara
Published: April 2024

The process of transitioning involves making changes to align one’s life with their authentic gender identity. This study explores the life trajectories of three Portuguese transgender women who transitioned later in life (50+ years old) by identifying key chapters in their life courses. Through inductive thematic analysis, six chapters were identified from the participants’ interviews: (1) awareness of “something different in me,” (2) locked into suffering, (3) finding comfort in something that is socially recognized, (4) “it is enough”: it is time to recognize and embrace the woman I am, (5) living my life as a woman, and (6) building and leaving a legacy. Aging and the process of self-discovery played pivotal roles in participants’ process of transitioning. The perception of finitude and the limitations associated with the time of life led them to realize that there was no time to waste and a sense of urgency to live authentically.
Spousal Involvement in Collaborative Management and Glycemic Behavior Change among Patients with Diabetes Mellitus: A Systematic Review
Authors: Pratiwi Ika Nur , Nursalam Nursalam , Widyawati Ika Yuni , Ramoo Vimala
Published: April 2024

Introduction

The marked increase in the number of individuals with diabetes mellitus (DM) worldwide each year has resulted in the importance of the spouse's contribution to the promotion and support of patient self-management programs.

Objectives

This study aimed to systematically explore the role or involvement of spouses in collaborative management and glycemic behavior change in DM.

Methods

Five databases including Scopus, PubMed, Cumulative Index of Nursing and Allied Health Literature, SAGE, and Web of Science were reviewed for relevant articles retrieved from 2017 to 2022. Literature search used keywords, including “Spouse,” “Support,” “Self-management,” “Glycemic Control,” and “Diabetes mellitus.” The Joanna Briggs Institute guidelines were used for appraisal review of journals. The component of partner support in the self-management of patients with DM is associated with an increase in the patient's glycemic level.

Results

Twenty-five studies were identified that describe the different spousal roles and strategies in the promotion and support of DM management. Overall, spouses’ involvement positively impacted healthy diets, higher self-efficacy, improved quality of psychological well-being, increased perceived support, and changes in glycemic-influenced behavior. Adaptation in the spouse patient relationship including maintaining cohesiveness can result in positive coping is essential in normalizing and contextualizing the chronic condition of DM. Partner-based collaboration is important for diabetes management, overcoming management barriers, and generating communal coping.

Conclusion

This systematic review observed that the involvement of a spouse is important in improving collaborative management and results in better glycemic behavior in patients with DM. A better understanding of the relationship between spousal involvement, coping strategies, and adherence in daily management and the subsequent use of this information are highly useful for creating targeted and effective interventions.
Age-specific sex-differences in cerebral blood flow velocity in relation to haemoglobin levels
Authors: Mazzucco Sara , Li Linxin , Tuna Maria Assuncao , Rothwell Peter M
Published: April 2024

Introduction:

Cerebral blood flow (CBF) declines with age and abnormalities in CBF are associated with age-related cerebrovascular disease and neurodegeneration. Women have higher CBF than men, although this sex-difference diminishes to some extent with age in healthy subjects. The physiological drivers of these age/sex differences are uncertain, but might be secondary to age and sex-differences in haemoglobin (Hb) level. Hb levels are inversely correlated with CBF, are lower in women, and decline with age in men, but the interrelations between these factors have not been explored systematically either in healthy subjects or across the full age-range in patients with vascular risk factors. We aimed to determine the age-specific interrelations between sex, Hb, and CBF velocity in a large cohort of patients with cerebrovascular disease.

Patients and methods:

In patients with a recent transient ischaemic attack or minor stroke (Oxford Vascular Study) and no ipsilateral or contralateral stenosis of the carotid or intracranial arteries, we related peak-systolic velocity (PSV) and other parameters on transcranial Doppler ultrasound (TCD) of the middle cerebral artery to sex, age, Hb and vascular risk factors.

Results:

Of 958 eligible subjects (mean age/SD = 68.04/14.26, 53.2% male), younger women (age < 55 years) had higher CBF velocities than men (mean sex difference in PSV at age < 55 years = 16.31 cm/s; p < 0.001), but this difference declined with age (interaction p < 0.001), such that it was no longer significant at age 75–84 (∆PSV = 3.26 cm/s; p = 0.12) and was reversed at age ⩾ 85 (∆PSV = −7.42 cm/s; p = 0.05). These changes mirrored trends in levels of Hb, which were higher in men at age < 55 (∆Hb = 1.92 g/dL; p < 0.001), but steadily decreased with age in men but not in women (interaction p < 0.001), with no residual sex-difference at age ⩾ 85 (∆Hb = 0.12 g/dL; p = 0.70). There was an inverse correlation between Hb and PSV in both women and men (both p ⩽ 0.01), and the sex-difference in PSV at age < 55 was substantially diminished after adjustment for Hb (∆PSV = 6.92; p = 0.036; ∆PSV = 5.92, p = 0.13 with further adjustment for end-tidal CO2). In contrast, the sex difference in PSV was unaffected by adjustment for systolic and diastolic blood pressure, heart rate, and vascular risk factors (history of hypertension, diabetes, hyperlipidaemia and smoking).

Discussion:

CBF velocity is strongly correlated with Hb level at all ages, and sex-differences in CBF velocity appear to be explained in major part by age-related sex-differences in Hb.
Assigning disease clusters to people: A cohort study of the implications for understanding health outcomes in people with multiple long-term conditions
Authors: Beaney Thomas , Clarke Jonathan , Salman David , Woodcock Thomas , Majeed Azeem , Barahona Mauricio , Aylin Paul
Published: April 2024

Background

Identifying clusters of co-occurring diseases may help characterise distinct phenotypes of Multiple Long-Term Conditions (MLTC). Understanding the associations of disease clusters with health-related outcomes requires a strategy to assign clusters to people, but it is unclear how the performance of strategies compare.

Aims

First, to compare the performance of methods of assigning disease clusters to people at explaining mortality, emergency department attendances and hospital admissions over one year. Second, to identify the extent of variation in the associations with each outcome between and within clusters.

Methods

We conducted a cohort study of primary care electronic health records in England, including adults with MLTC. Seven strategies were tested to assign patients to fifteen disease clusters representing 212 LTCs, identified from our previous work. We tested the performance of each strategy at explaining associations with the three outcomes over 1 year using logistic regression and compared to a strategy using the individual LTCs.

Results

6,286,233 patients with MLTC were included. Of the seven strategies tested, a strategy assigning the count of conditions within each cluster performed best at explaining all three outcomes but was inferior to using information on the individual LTCs. There was a larger range of effect sizes for the individual LTCs within the same cluster than there was between the clusters.

Conclusion

Strategies of assigning clusters of co-occurring diseases to people were less effective at explaining health-related outcomes than a person’s individual diseases. Furthermore, clusters did not represent consistent relationships of the LTCs within them, which might limit their application in clinical research.