bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Normative Behaviourism Offer an Alternative Methodology in Political Theory?
Authors: Erman Eva , Möller Niklas
Published: February 2023

A central distinction for Jonathan Floyd is that between the traditional method of pursuing political theory conducted by mainstream theorists, which he calls ‘mentalism’, and his suggested method, so-called ‘normative behaviourism’. While the former relies on patterns of thought (e.g. intuitions, value commitments, principles or considered judgements) to justify normative theories, the latter instead relies on patterns of behaviour. Floyd argues that normative behaviourism offers an alternative methodology to mainstream mentalism, a new – and better – way of doing political philosophy. Our aim in this article is to reject this claim: normative behaviourism does not offer an alternative methodology in political theory. First, we show that normative behaviourism, contrary to Floyd’s claim, is as dependent on value premises as mainstream, ‘mentalist’ political theory. Second, we illustrate the structural similarities between normative behaviourism and mainstream political theory from a methodological standpoint by comparing the former with an influential normative theory, namely, utilitarianism.
Livestreaming Technology and Online Child Sexual Exploitation and Abuse: A Scoping Review
Authors: Drejer Catharina , Riegler Michael A. , Halvorsen Pål , Johnson Miriam S. , Baugerud Gunn Astrid
Published: February 2023

Livestreaming of child sexual abuse (LSCSA) is an established form of online child sexual exploitation and abuse (OCSEA). However, only a limited body of research has examined this issue. The Covid-19 pandemic has accelerated internet use and user knowledge of livestreaming services emphasizing the importance of understanding this crime. In this scoping review, existing literature was brought together through an iterative search of eight databases containing peer-reviewed journal articles, as well as grey literature. Records were eligible for inclusion if the primary focus was on livestream technology and OCSEA, the child being defined as eighteen years or younger. Fourteen of the 2,218 records were selected. The data were charted and divided into four categories: victims, offenders, legislation, and technology. Limited research, differences in terminology, study design, and population inclusion criteria present a challenge to drawing general conclusions on the current state of LSCSA. The records show that victims are predominantly female. The average livestream offender was found to be older than the average online child sexual abuse offender. Therefore, it is unclear whether the findings are representative of the global population of livestream offenders. Furthermore, there appears to be a gap in what the records show on platforms and payment services used and current digital trends. The lack of a legal definition and privacy considerations pose a challenge to investigation, detection, and prosecution. The available data allow some insights into a potentially much larger issue.
The Potential Role of Social Media in Peacebuilding in Zimbabwe
Authors: Ndawana Enock
Published: February 2023

This article uses securitisation theory to examine the Zimbabwean government's handling of protests and protesters’ use of social media. It is based on the case study of Harare and data gathered from both primary and secondary sources. The article argues that securitisation of the right to protest in Zimbabwe forecloses opportunities for engagement, which negatively affects peace and development. It asserts that social media platforms’ capacity to mobilise discontented citizens for protests can be used by Zimbabwean policy makers to engage the citizens and enhance the formulation and development of pro-peace and development policy initiatives. The article concludes that embracing relevant digital technologies, particularly social media platforms, can offer broader policy engagement opportunities and thereby minimise protests by disgruntled citizens.
Modeling efficiency and safety on an aircraft carrier flight deck
Authors: Cummings Mary L , Li Songpo , Han Hong , Aguilar Carlos
Published: February 2023

Aircraft carrier flight decks present high-risk mission-critical environments that need to be both efficient and safe. The concept of optimal manning, having just enough people to do the job safely and efficiently, is paramount in order to put the least amount of people at risk while not sacrificing mission effectiveness. To this end, an agent-based model, the optimal manning simulation (OMS) was developed, which specifically looks at the launch process of the flight deck in order to quantify the risk and efficiency of people working on the flight deck. OMS models different classes of crew members on the flight deck, aircraft, and resources like catapults. OMS measures safety through collisions or near-collisions of people and aircraft, as well as how long it takes to execute a launch cycle, the primary efficiency metric. Validation and sensitivity analyses provide confidence in OMS results. To demonstrate its utility, OMS is also used to predict how the future introduction of unmanned aerial vehicles could impact staffing and performance measures.
The Intersection of Bullying and Intimidation in an Urban High School
Authors: Winterman Kathleen G. , Burton Brett A.
Published: February 2023

The lack of support for transfer students, specifically students with individualized education plans (IEP) into school environments, is problematic. At times, IEP students face additional obstacles and challenges due to their disabilities compared to the regular education population. The authors formulated a case that follows an IEP transfer student and his parents in a school environment that has seen an increase in its student population with bullying, harassment, and intimidation. This article illustrates the barriers IEP students and parents may encounter when seeking protection and solutions for their students in a hierarchical school system.
The Power of a Camera: Fieldwork Experiences From Using Participatory Photovoice
Authors: Bandauko Elmond , Arku Godwin
Published: February 2023

Conducting primary data collection can be a fulfilling and interesting adventure producing significant learning experiences particularly for early career researchers. However, fieldwork can be marred with complex challenges and frustrations, especially if conducted in dynamic and politically sensitive environments and with highly vulnerable urban populations. This paper contributes to and advances academic scholarship on fieldwork experiences in the social sciences. Drawing from the first author’s doctoral fieldwork experiences, we share our reflections on the application of the photovoice method in researching street traders in Harare, Zimbabwe. We engage with different issues that researchers could consider in the application of photovoice, especially with dynamic and marginalized urban populations like street traders. These include dealing with and managing complex and multiple ethical dilemmas, dealing with the content-quality conundrum, exploring ‘missing’ photographs and handling ‘leftover’ photographs, handling conflictual council-street trader relations, building rapport, and ensuring participant commitment, joint interpretation, and co-construction of meaning and methodological benefits of using photovoice with street traders. To the best of our knowledge, this is the first paper that reflects on the use of photovoice with street traders in Global South cities, and we hope that the insights presented here will be useful for future urban researchers working on similar topics.
March of the kitten herders
Authors: Woodward Keith
Published: February 2023

Everything is affective; every thing is infrastructural. Or: (1) affectivity is the relational force of materiality and (2) a thing is the convergence of a range of relations and is itself a compositional element of others. Or again: if affect and infrastructure associate, it is on the order of what, in 2010, I called ‘abrupt conditions’ and tend, sometimes, toward the organization of a ‘site’. This dynamic system is ontologically ‘flat’ in the sense that it does not prioritize in advance any entities or relations. However, all such emergence negotiates an already complex, actual system of social unevenness because it unfolds amidst sociality ( everything is affective; every thing is infrastructural). Thus, while I agree with almost all of Bosworth's (2023) treatment of affective infrastructures, our understandings diverge on the political consequences of flatness. Pace Bosworth, a ‘first’ philosophy of emergence (flatness) is necessary for conceiving the possibility of actual change and, by extension, for realizing efforts to abolish unevenness. What follows animates this notion through several gestures to the banal sociality of academic working life and intellectual exchange, its confused affinities and familiar misunderstandings, its good vibes and bad energies.
Helping the Helpers: Adaptation and Evaluation of Stress First Aid for Healthcare Workers in the Veterans Health Administration During the COVID-19 Pandemic
Authors: McLean Carmen P. , Betsworth Deborah , Bihday Christine , Daman Megan C. , Davis C. Adrian , Kaysen Debra , Rosen Craig S. , Saxby Dyani , Smith Ann E. , Spinelli Sam , Watson Patricia
Published: February 2023

Background:

Early interventions are needed to support the behavioral health of healthcare staff in the context of the COVID-19 pandemic. Stress First Aid (SFA) is a self-care and peer support model for reducing burnout and stress that is designed for use in high-stress occupations.

Methods:

We conducted a mixed-methods evaluation of an SFA program in the Veterans Health Administration (VHA). This brief, multi-session, didactic program was adapted for hospital workgroups. Program attendees completed a survey assessing implementation outcomes, burnout, stress, mood, and SFA skills at the beginning ( N = 246) and end ( n = 94) of the SFA program and a subgroup ( n = 11) completed qualitative feedback interviews.

Findings:

Program acceptability, appropriateness, and feasibility were rated highly. From pre- to post-SFA, the impact of the pandemic on stress and anxiety, as well as proficiency in supporting peers increased. Qualitative findings suggest the program provided a shared language to discuss stress, normalized stress reactions, met a need for stress management tools, and helped staff feel valued, empowered, connected with each other. Staff reported being more aware of their stress, but SFA was insufficient to address many of the systemic sources of burnout and stress.

Conclusions and Applications to Practice:

While the SFA program was well received, the impact of brief programs is likely to be modest when implemented in the middle of an ongoing pandemic and when burnout arises from chiefly from systemic sources. Lessons learned during the program implementation that may guide future efforts are discussed.
Radial Extracorporeal Shock Wave Therapy Enhances Graft Maturation at 2-Year Follow-up After ACL Reconstruction: A Randomized Controlled Trial
Authors: Zhang Shurong , Wen Aizhen , Li Shengkun , Yao Wei , Liu Chang , Lin Zifan , Jin Zhengbiao , Chen Jiwu , Hua Yinghui , Chen Shiyi , Li Yunxia
Published: February 2023

Background:

Graft maturation is an important prognostic factor for hamstring autograft anterior cruciate ligament reconstruction (ACLR). It remains unclear whether extracorporeal shock wave therapy (ESWT) can promote graft healing after ACLR.

Purpose:

To evaluate the therapeutic and graft maturation effects of ESWT in hamstring autograft ACLR.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

Between May 18, 2019, and September 20, 2019, we randomly assigned 30 patients who met study inclusion criteria to 2 groups. Patients in the control group followed a 5-week advanced rehabilitation training program (30 minutes/session, 5 times/week) starting at 3 months postoperatively. In the ESWT group, together with the 5-week advanced rehabilitation training, radial ESWT was applied once a week for 5 weeks. Functional scores (Lysholm, International Knee Documentation Committee, and Tegner scores), KT-1000 arthrometer knee laxity measurement, and magnetic resonance imaging scans were assessed at 3 months (baseline), 6 months, and 24 months postoperatively. To evaluate graft maturation, we assessed the graft signal-to-noise quotients (SNQs) of the tibial, intra-articular, and femoral sides on magnetic resonance imaging scans. Data were compared between the ESWT and control groups.

Results:

In total, 26 patients (13 with ESWT, 13 controls) were assessed. There were no significant between-group differences on any assessment at baseline, and no significant within-group or between-group differences were found in knee laxity at any point. At 24-month follow-up, the ESWT group had significantly higher Lysholm and Tegner scores compared with the controls ( P = .012 and .017, respectively). Regarding graft maturation, at 6-month follow-up, the SNQ of the tibial intraosseous graft was significantly lower in the ESWT group versus controls ( P = .006), but no differences were detected at the femoral intraosseous graft ( P = .321) or the intra-articular graft ( P = .314). At 24-month follow-up, the SNQs of the femoral intraosseous graft and intra-articular graft were significantly lower in the ESWT group versus controls ( P = .020 and .044, respectively) but no difference was found at the tibial intraosseous graft ( P = .579).

Conclusion:

Both enhanced graft maturation and improved functional scores at 24-month follow-up were seen in patients who received radial ESWT during rehabilitation after hamstring autograft ACLR.

Registration:

ChiCTR1900022853 (Chinese Clinical Trial Registry).
Patient Decision Making in Anterior Cruciate Ligament Reconstruction: A Discrete Choice Experiment Examining Graft Preference
Authors: Sonnier John Hayden , Paul Ryan W. , Sando Hayden E. , Hall Anya T. , Tjoumakaris Fotios P. , Cohen Steven B. , Freedman Kevin B.
Published: February 2023

Background:

Bone–patellar tendon–bone (BTB) and hamstring autografts are the most common grafts used for anterior cruciate ligament (ACL) reconstruction. Patient preferences should be accounted for as a part of shared decision making.

Purpose/Hypothesis:

The purpose of this study was to perform a discrete choice experiment that evaluated patient preferences toward ACL autografts. We hypothesized that there would be no difference in patient preferences between groups.

Study Design:

Cross-sectional study.

Methods:

Patients aged 18 to 25 years who underwent shoulder arthroscopy at a single institution between 2013 and 2019 were included in the study as a proxy for healthy controls. Patients with a history of ACL tear were excluded. A discrete choice experiment was developed from a literature search and used the following data points as they pertain to BTB or hamstring autograft: risk of developing a significant complication, return-to-play rate, risk of anterior knee pain with kneeling, and risk of additional surgery due to graft failure. Included patients completed a custom survey in which they were asked to choose between “surgery A” (hamstring) and “surgery B” (BTB).

Results:

A total of 107 participants were included in the analysis. Of these participants, 39 (36.5%) chose surgery A (hamstring) and 68 (63.6%) chose surgery B (BTB). When comparing the hamstring group with the BTB group, there was no significant difference in age, sex, body mass index, race, level of education, or employment status. However, 80.5% of self-reported athletes preferred BTB ( P = .008). When controlling for age, sex, and body mass index, patients in the BTB group were more likely to rate return to sport (risk ratio [RR] = 1.49 [95% CI, 1.18-1.98]; P = .001) and the risk of requiring additional surgery due to graft failure (RR = 1.26 [95% CI, 1.02-1.58]; P = .037) as highly important. Conversely, they were less likely than patients in the hamstring group to rate pain while kneeling (RR = 0.65 [95% CI, 0.98-1.05]; P < .001) and complication risk (RR = 0.75 [95% CI, 0.59-0.94]; P = .013) as important.

Conclusion:

The study hypothesis was rejected, as patient values did affect ACL graft choice preference. Utilizing patient-selected values in a quantifiable way can benefit the shared decision-making process before ACL reconstruction.
Anti-Muslim Surveillance: Canadian Muslims’ Experiences with CSIS
Authors: Nagra Baljit , Maurutto Paula
Published: February 2023

The targeting of Muslim communities through “the War on Terror” has given rise to a variety of schemes and tactics informed by Islamophobia and racializing narratives. Yet, there are few studies examining the specific intelligence practices deployed by governments as they engage in forms of racialized surveillance. This study analyses 95 in-depth interviews with Muslim community leaders in five Canadian cities to map the material structural practices employed by the Canadian Security Intelligence Services (CSIS) in its racialized surveillance of Muslim communities. This study documents how CSIS engages in the mass surveillance of Muslim communities, transforms Mosques into spaces of surveillance, creates a community of informants, and targets political activism. Moreover, we found that CSIS deploys illegal practices such as threatening citizenship and refugee status, intimidating people in their homes during the night and denying legal representation during interrogations. The article also explores how these state-led anti-Muslim surveillance tactics produce internal forms of community surveillance where individuals begin to self-regulate their own behavior. The level of CSIS surveillance of Muslim communities raises questions about the extent to which CSIS is overstepping its powers and engaging in illegal practices.
With Equity in Mind: A Systematic Review of Recognition Practices for Migrants and Refugees in the European Context
Authors: Pastore Serafina , Delville Aleidis , Colosimo Marianna , Scardigno Fausta , Manuti Amelia
Published: February 2023

The attention deserved to the recognition of qualifications (degrees) and competencies acquired elsewhere, as a means for equity and inclusion in education has progressively influenced educational research and also educational policy and decision-making. Different European countries, agreeing with the importance of valorising informal learning, have expressed the need to make learning ‘beyond the classroom’ visible and to assess it in a more responsive and effective way. Despite the common educational policy framework, in the European area, students with a migratory background (i.e., migrants and/or refugees) continue to struggle in accessing university paths. Given the persistent difficulties in ensuring migrants and refugees equal access to education and training opportunities, this article reports a systematic review study focused on recognition practices realized, over the last 5 years, in the European higher education context. Against the backdrop of the learning recognition debate, the results of this literature review study show a scattered landscape of local practices, sometimes, misaligned with the educational policies defined at the European level. The present study represents a useful step in reflecting on what actions are expected to be designed and implemented by higher education institutions in order to ensure a culturally responsive and equitable education for all.
Longitudinal outcomes of employment, income and housing for Flemish care leavers
Authors: Gypen Laura , Stas Lara , West Delphine , Van Holen Frank , Vanderfaeillie Johan
Published: February 2023

Care leavers are more often unemployed, have lower annual earnings and live in inferior housing circumstances than their peers in the general population. International research has extensively studied and discussed these outcomes. However, in Flanders (the Dutch speaking part of Belgium), no previous quantitative studies are known. This study therefore explores and predicts outcomes on employment, income and housing circumstances of care leavers in Flanders and investigates if these outcomes improve in the years after leaving care. Associations with placement factors are explored to support recommendations to the clinical field. The current study involves 175 care-leavers (both family foster care ( n = 105) and residential care ( n = 70)). Data was collected using a self-reporting questionnaire touching multiple domains. The participants of the study (49 male, 126 female) are between 18 and 27 years old. Care leavers are employed at younger ages but are also more often unemployed than their peers from the general population, they earn significantly less than peers and are more often homeless. On all domains, no significant differences were found between foster- and residential care leavers. Placement characteristics are more declaratory than only the type of care. In the current study, most outcomes improve during the years after leaving care, this supports the theory of emerging adulthood. Although we cannot infer causal effects, care leavers who experienced fewer placement changes and received individual therapy during their time in care tend to have better outcomes in the current study. The same applies for care leavers who were prepared for leaving care and supported after leaving care. Policy makers should focus on increased support regarding breakdown prevention and individual mental health support during the time in care. Preparation for placement ending and aftercare should be provided.
SARS-CoV-2 and Hypertension: Evidence Supporting Invasion into the Brain Via Baroreflex Circuitry and the Role of Imbalanced Renin-Angiotensin-Aldosterone-System
Authors: Oliveira Kellysson Bruno , Melo Igor Santana de , Silva Bianca Rodrigues Melo da , Oliveira Keylla Lavínia da Silva , Sabino-Silva Robinson , Anhezini Lucas , Katayama Pedro Lourenco , Santos Victor Rodrigues , Shetty Ashok K , Castro Olagide Wagner de
Published: February 2023

Hypertension is considered one of the most critical risk factors for COVID-19. Evidence suggests that SARS-CoV-2 infection produces intense effects on the cardiovascular system by weakening the wall of large vessels via vasa-vasorum. In this commentary, we propose that SARS-CoV-2 invades carotid and aortic baroreceptors, leading to infection of the nucleus tractus solitari (NTS) and paraventricular hypothalamic nucleus (PVN), and such dysregulation of NTS and PVN following infection causes blood pressure alteration at the central level. We additionally explored the hypothesis that SARS-CoV-2 favors the internalization of membrane ACE2 receptors generating an imbalance of the renin-angiotensin-aldosterone system (RAAS), increasing the activity of angiotensin II (ANG-II), disintegrin, and metalloproteinase 17 domain (ADAM17/TACE), eventually modulating the integration of afferents reaching the NTS from baroreceptors and promoting increased blood pressure. These mechanisms are related to the increased sympathetic activity, which leads to transient or permanent hypertension associated with SARS-CoV-2 invasion, contributing to the high number of deaths by cardiovascular implications.
Arthroscopic Anatomic Glenoid Reconstruction in the Unstable Shoulder: Technique, Pearls, and Pitfalls
Authors: Joannette-Bourguignon Maude , Wong Ivan
Published: February 2023

Background:

Anterior shoulder instability with glenoid bone loss is a complex condition. Bankart repairs have higher failure rate in this population and the Latarjet procedure is associated with a high complication rate (15%-30%). A recent technique, the arthroscopic anatomic glenoid reconstruction, safely uses distal tibial allograft to augment the glenoid.

Indications:

Glenoid or bipolar bone loss in the setting of shoulder instability.

Technique Description:

A diagnostic shoulder arthroscopy is performed to assess bone loss and capsulolabral tissue. After the preparation of the anterior glenoid, a bone block harvested from a distal tibial allograft is prepared. This technique uses the Halifax portal, a safe, far medial portal to insert the graft, and compress it onto the anterior glenoid using screws. A Bankart repair is then performed, to reduce the capsulolabral complex onto the glenoid.

Results:

Results at 2 years show a 92% to 100% union of the graft, no recurrence of instability, and improved patient-reported outcome scores. Graft remodeling is regularly observed on postoperative imaging. This procedure may be faster to learn and to perform compared to an arthroscopic Latarjet.

Discussion/Conclusion:

Arthroscopic anatomic glenoid reconstruction is a safe, minimally invasive procedure to address shoulder instability. It has low complication rate and is associated with improved patient-reported outcomes.

Patient Consent Disclosure Statement:

The author(s) attest that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Effects of Person-Centered Information for Parents of Children With Cancer (the PIFBO Study): A Randomized Controlled Trial
Authors: Ringnér Anders , Björk Maria , Olsson Cecilia
Published: February 2023

Background: Conveying information to parents is a core part of pediatric oncology nursing; however, most published interventions do not tailor information to individual parental needs. Objective: To evaluate the effect on parental illness-related stress of person-centered information provided to parents of children with cancer. Methods: A multicenter, unblinded randomized controlled trial with two parallel arms recruiting parents of children diagnosed within the past two months from two tertiary children's cancer centers in Sweden. Parents were randomized using sealed envelopes prepared and opened by an independent person. Parents in the intervention arm met four times with experienced nurses trained in the intervention, whereas controls received standard care. The effect of the intervention was measured five times regarding parents’ illness-related stress. Secondary outcomes were psychosocial states, experiences with healthcare providers, and received information. Further, we collected process data on the intervention's content and fidelity. Results: Of the 32 parents included and analyzed in the study, 16 were randomized to the intervention, which addressed a broad variety of topics. The intervention increased parents’ knowledge about the biophysiological and functional aspects of their child's illness, but it had no measurable effect on their distress. Discussion: Although fidelity to the intervention protocol was sufficient, the study was flawed by recruitment difficulties, primarily due to organizational factors, which may have prevented us from observing any possible effects on psychosocial distress. Having a person-centered perspective could be promising for future studies aimed at parents of children with cancer. (Registered at Clinicaltrials.gov, number NCT02332226.)
Stepwise transition of urban entrepreneurialism in cross-boundary statecraft: A qualitative study of an enclave industrial park in Zhejiang province, China
Authors: Zhang Xianchun , Zhou Zihang , Yang Yu
Published: February 2023

This study examines the roles and ideologies of cross-boundary statecraft in the context of urban entrepreneurialism in multi-level bureaucratic China. Referring to comparative studies on city diplomacy, intrapreneurialism, and state entrepreneurialism, we conducted a case study of Quzhou Inno-Industrial Park (QIIP) (an enclave industrial park) in Zhejiang province to clarify the nature of territorial rationality in cross-boundary development. We thus found that entrepreneurial objectives were fulfilled through top-down politics, wherein roles played by the central, provincial, and municipal governments were differentiated in territorial expressions. First, the provincial government actualized central government initiatives by promulgating developmental agenda and distributing to municipalities under state entrepreneurialism. Second, municipalities forged independent territorial rationality to benefit bilateral development through city diplomacy when releasing cross-boundary cooperation schemes. Third, multiple governments have chosen speculative and experimental practices over passive compliance with allegiances through top-down bureaucratic dictates, thus fulfilling provincial developmental intentions within territorial incentives of local benefits. Overall, these findings reveal an arrangement that greatly differs from a fixed modality of urban entrepreneurialism, wherein cross-boundary statecraft exposes stepwise genres in a transitional spectrum of urban entrepreneurialism that reflects perceptions of multi-level bureaucratic China.
(In)Equity and Primary Health Care: The Case of Costa Rica and Panama
Authors: Baird Madeline
Published: February 2023

The 1970s marked a significant opportunity for improving primary health care globally. Yet, political will and widescale investment to achieve “health for all” vastly diverged in countries across the Americas in the decades that followed. Distinct ideologies and models of health care emerged following commitments to social investment, equity, and community participation at Alma-Ata. In the 1970s, Costa Rica scaled up its national health system and increased broad social investment. In Panama, the establishment of the Ministry of Health in 1969 coincided with broad state investment in primary health care, yet the emergence of neoliberal models based on efficiency and privatization in the decades that followed undermined efforts toward health equity. Models of state-sanctioned investment and policies diverged in their framing of ideas about the right to health, characterized by broad social investment in Costa Rica addressing the structural factors of ill health versus financing stratified health systems and select biomedical interventions in Panama. These case studies describe the historical, political, economic, and social dimensions that account for the distinct framing of ideas about right to health and health equity and enabled Costa Rica to diverge as a country with one of the most effective health systems in the region.
A validated composite comorbidity index predicts outcomes of CAR T-cell therapy in patients with diffuse large B-cell lymphoma
Authors: Shouse Geoffrey , Kaempf Andy , Gordon Max J. , Artz Andy , Yashar David , Sigmund Audrey M. , Smilnak Gordon , Bair Steven M. , Mian Agrima , Fitzgerald Lindsey A. , Bajwa Amneet , Jaglowski Samantha , Bailey Neil , Shadman Mazyar , Patel Krish , Stephens Deborah M. , Kamdar Manali , Hill Brian T. , Gauthier Jordan , Karmali Reem , Nastoupil Loretta J. , Kittai Adam S. , Danilov Alexey V.
Published: February 2023

Chimeric antigen receptor T-cell therapy (CART) has extended survival of patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL). However, limited durability of response and prevalent toxicities remain problematic. Identifying patients who are at high risk of disease progression, toxicity, and death would inform treatment decisions. Although the cumulative illness rating scale (CIRS) has been shown to correlate with survival in B-cell malignancies, no prognostic score has been independently validated in CART recipients. We retrospectively identified 577 patients with relapsed/refractory DLBCL indicated for CART at 9 academic centers to form a learning cohort (LC). Random survival forest modeling of overall survival (OS) and progression-free survival (PFS) was performed to determine the most influential CIRS organ systems and severity grades. The presence of a severe comorbidity (CIRS score ≥ 3) in the respiratory, upper gastrointestinal, hepatic, or renal system, herein termed “Severe4,” had the greatest impact on post-CART survival. Controlling for other prognostic factors (number of prior therapies, Eastern Cooperative Oncology Group performance status, BCL6 translocation, and molecular subtype), Severe4 was strongly associated with shorter PFS and OS in the LC and in an independent single-center validation cohort (VC). Severe4 was also a significant predictor of grade ≥3 cytokine release syndrome in the LC, while maintaining this trend in the VC. Thus, our results indicate that adverse outcomes for patients with DLBCL meant to receive CART can be predicted using a simplified CIRS-derived comorbidity index.
What is the optimal management of potentially resectable stage III-N2 NSCLC? Results of a fixed-effects network meta-analysis and economic modelling
Authors: Evison Matthew , Maconachie Ross , Mercer Toby , Daly Caitlin H. , Welton Nicky J. , Aslam Shahzeena , West Doug , Navani Neal
Published: February 2023

Introduction

There is a critical need to understand the optimal treatment regimen in patients with potentially resectable stage III-N2 nonsmall cell lung cancer (NSCLC).

Methods

A systematic review of randomised controlled trials was carried out using a literature search including the CDSR, CENTRAL, DARE, HTA, EMBASE and MEDLINE bibliographic databases. Selected trials were used to perform a Bayesian fixed-effects network meta-analysis and economic modelling of treatment regimens relevant to current-day treatment options: chemotherapy plus surgery (CS), chemotherapy plus radiotherapy (CR) and chemoradiotherapy followed by surgery (CRS).

Findings

Six trials were prioritised for evidence synthesis. The fixed-effects network meta-analyses demonstrated an improvement in disease-free survival (DFS) for CRSversusCS and CRSversusCR of 0.34 years (95% CI 0.02–0.65) and 0.32 years (95% CI 0.05–0.58) respectively, over a 5-year period. No evidence of effect was observed in overall survival although point estimates favoured CRS. The probabilities that CRS had a greater mean survival time and greater probability of being alive than the reference treatment of CR at 5 years were 89% and 86% respectively. Survival outcomes for CR and CS were essentially equivalent. The economic model calculated that CRS and CS had incremental cost-effectiveness ratios of £19 000/quality-adjusted life-year (QALY) and £78 000/QALY compared to CR. The probability that CRS generated more QALYs than CR and CS was 94%.

Interpretation

CRS provides an extended time in a disease-free state leading to improved cost-effectiveness over CR and CS in potentially resectable stage III-N2 NSCLC.
The national COPD screening programme in China: rationale and design
Authors: Lei Jieping , Huang Ke , Pan Jun , Li Wei , Niu Hongtao , Ren Xiaoxia , Dong Fen , Li Yong , Li Baicun , Jia Cunbo , Yang Ting , Wang Chen
Published: February 2023

Background

COPD is the most prevalent chronic respiratory disease in China. It is estimated that there is a large, as-yet undetected, high-risk population who will develop in COPD in future.

Methods and design

In this context, a nationwide COPD screening programme was launched on 9 October 2021. This multistage sequential screening programme incorporates a previously validated questionnaire (i.e.COPD Screening Questionnaire) and pre- and post-bronchodilator spirometry to target the COPD high-risk population. The programme plans to recruit 800 000 participants (eligible age 35–75 years) from 160 districts or counties of 31 provinces, autonomous regions or municipalities across China. The filtered COPD high-risk population and early-detected COPD patients will receive integrated management and be followed-up for ≥1 year.

Discussion

This is the first large-scale prospective study to determine the net benefit of mass screening for COPD in China. Whether the smoking cessation rate, morbidity, mortality and health status of individuals at high risk of COPD could be improved along with this systematic screening programme will be observed and validated. Moreover, the diagnostic accuracy, cost-effectiveness and superiority of the screening programme will also be assessed and discussed. The programme marks a remarkable achievement in the management of chronic respiratory disease in China.
MXene: fundamentals to applications in electrochemical energy storage
Authors: Ampong Daniel Nframah , Agyekum Emmanuel , Agyemang Frank Ofori , Mensah-Darkwa Kwadwo , Andrews Anthony , Kumar Anuj , Gupta Ram K.
Published: February 2023

A new, sizable family of 2D transition metal carbonitrides, carbides, and nitrides known as MXenes has attracted a lot of attention in recent years. This is because MXenes exhibit a variety of intriguing physical, chemical, mechanical, and electrochemical characteristics that are closely linked to the wide variety of their surface terminations and elemental compositions. Particularly, MXenes are readily converted into composites with materials including oxides, polymers, and CNTs, which makes it possible to modify their characteristics for a variety of uses. MXenes and MXene-based composites have demonstrated tremendous promise in environmental applications due to their excellent reducibility, conductivity, and biocompatibility, in addition to their well-known rise to prominence as electrode materials in the energy storage sector. The remarkable characteristics of 2D MXene, including high conductivity, high specific surface area, and enhanced hydrophilicity, account for the increasing prominence of its use in storage devices. In this review, we highlight the most recent developments in the use of MXenes and MXene-based composites for electrochemical energy storage while summarizing their synthesis and characteristics. Key attention is paid to applications in supercapacitors, batteries, and their flexible components. Future research challenges and perspectives are also described.
Clinical significance of the hemodynamic gain index in patients undergoing exercise stress testing and coronary computed tomography angiography
Authors: Mansour Mohamad Jihad , Chammas Elie , Winkler Michael , AlJaroudi Wael
Published: February 2023

Background

Many hemodynamic parameters provide limited information regarding obstructive coronary artery disease (CAD) during exercise stress testing particularly when exercise is suboptimal. Hemodynamic gain index (HGI) is a recent sensitive indicator of ischemia and has been associated with increased mortality. This study evaluated the clinical impact of HGI in patients who underwent concomitant exercise stress testing and coronary computed tomography angiography (CCTA).

Methods

A total of 284 consecutive patients from the executive health program between 2010 and 2018 were identified. Resting and peak heart rate (HR) as well as systolic blood pressure (SBP) measurements were recorded. Framingham risk score (FRS), Duke treadmill score (DTS) and HGI $$(\frac{{{\text{HRpeak}} \times {\text{SBPpeak}} - {\text{HRrest}} \times {\text{SBPrest}}}}{{{\text{HRrest}} \times {\text{SBPrest}}}})$$

(

HRpeak
×
SBPpeak
-
HRrest
×
SBPrest

HRrest
×
SBPrest

)

were calculated. The latter was divided into quartiles. CCTA was used as a reference test to detect any CAD. Multivariate analysis and artificial neural network were used to determine the independent predictors of obstructive CAD.

Results

Mean age was 53 ± 12 years with 83% male. Mean HGI was 1.74 ± 0.67, with cut-off value of severely blunted HGI ≤ 1.25 (Quartile 4). Patients with severely blunted HGI were older, had higher FRS, and worse DTS. Patients with obstructive CAD had lower HGI when compared to those with normal CCTA/non-obstructive CAD (1.36 ± 0.53 vs. 1.77 ± 0.67, P = 0.005), and showed a higher prevalence of severely blunted HGI (44% vs. 22%, P = 0.019). After adjusting for traditional risk factors, HGI remained an independent predictor of obstructive CAD while severely blunted HGI was associated with threefold increased odds of having obstructive CAD (P = 0.05). Using artificial intelligence analysis, severely blunted HGI independently predicted obstructive CAD with an area under the curve of 0.83 and 0.96, and normalized importance of HGI of 100% and 63%, respectively for different models.

Conclusions

Among patients who underwent concomitant exercise stress testing and CCTA, severely blunted HGI independently predicted obstructive CAD after multivariate adjustment for traditional risk factors.
Frailty nurse and GP-led models of care in care homes: the role of contextual factors impacting Enhanced health in care homes framework implementation
Authors: Sattar Zeibeda , Young-Murphy Lesley , Craig Lynn , Steven Alison , Wilson-Menzfeld Gemma
Published: February 2023

Background

The Enhanced Health for Care homes (EHCH) framework is an innovative response to provide more proactive, preventative approaches to care for residents living in care homes. It involves co-producing a shared vision with primary care. As part of EHCH a UK clinical commissioning group supported GP’s in two localities to implement their preferred delivery approach involving a new Frailty Nurse-led (FN-led) model in care homes alongside an existing General Practitioner-led (GP-led) model. This paper focuses on implementation of the new FN-led model.

Methods

A qualitative study design was adopted. Forty-eight qualitative semi-structured interviews were undertaken across six care home sites in a Northern locality: three implementing the FN-led and three engaged in an existing GP-led model. Participants included residents, family members, care home managers, care staff, and health professionals working within the EHCH framework.

Results

Two overarching themes were generated from data analysis: Unanticipated implementation issues and Unintended consequences. Unsuccessful attempts to recruit Frailty Nurses (FN) with enhanced clinical skills working at the desired level (UK NHS Band 7) led to an unanticipated evolution in the implementation process of the FN-led model towards ‘training posts’. This prompted misaligned role expectations subsequently provoking unexpected temporary outcomes regarding role-based trust. The existing, well understood nature of the GP-led model may have further exacerbated these unintended consequences.

Conclusion

Within the broader remit of embedding EHCH frameworks, the implementation of new FN roles needed to evolve due to unforeseen recruitment issues. Wider contextual factors are not in the control of those developing new initiatives and cannot always be foreseen, highlighting how wider factors can force evolution of planned implementation processes with unintended consequences. However, the unintended consequences in this study highlight the need for careful consideration of information dissemination (content and timing) to key stakeholders, and the influence of existing ways of working.
The genetic predisposition increases the chances of schoolchildren maintaining higher adiposity levels after three years
Authors: Reuter Éboni Marília , Reuter Cézane Priscila , de Castro Silveira João Francisco , Sehn Ana Paula , Todendi Pâmela Ferreira , de Moura Valim Andréia Rosane , Brazo-Sayavera Javier , de Mello Elza Daniel
Published: February 2023

Background

The behavior of anthropometrics and the relationship with genetic factors through a long-term perspective should be better explored. This study aims to verify the odds of maintaining the nutritional status classification after three years, according to the rs9939609 polymorphism (FTO gene).

Methods

It was a retrospective longitudinal study with 355 schoolchildren (7–17 years). Body mass index, body-fat percentage (BF%), and waist circumference (WC) were measured at baseline and follow-up. The FTO gene was evaluated from blood collection and genotyping performed by real-time polymerase chain reaction. Odds ratios and 95% confidence intervals were calculated.

Results

For those homozygous with the A allele, the odds of being at less favorable classification at follow-up were 2.29 (1.24; 4.22) and 4.05 (2.08; 7.86) times higher than expected for BF% and WC, respectively, whereas the odds of being in the more favorable classification at follow-up were 0.34 (0.12; 0.93) and 0.11 (0.01; 0.78) for BF% and WC, respectively. The odds of being at less favorable classification were higher for AA carriers with less favorable classification at baseline for BF% and WC compared to AT and TT carriers.

Conclusions

Schoolchildren with a genetic predisposition to obesity and unfavorable anthropometric profile at baseline had more chances of maintaining their nutritional status after three years of follow-up.
Predicting COVID-19 vaccination intentions: the roles of threat appraisal, coping appraisal, subjective norms, and negative affect
Authors: Zou Xia , Chen Qiang , Zhang Yangyi , Evans Richard
Published: February 2023

Background

As a new disease, communities possess little natural immunity to COVID-19 and vaccines are considered critical to preventing and reducing the incidence of severe illness. This study, inspired by Protection Motivation Theory (PMT), examines the relationship between citizens’ threat appraisal, coping appraisal, subjective norms, negative affect, and their COVID-19 vaccination intentions.

Methods

A sample of 340 citizens from two main cities in Mainland China, Xi’an and Wuxi, was used for data analysis. Structural Equation Modeling (SEM) was employed with latent and observed variables to test hypotheses. Data were analyzed using AMOS 24.0.

Results

Several findings extend current understanding. Firstly, our proposed model explains 73% of the variance in vaccination intentions. Secondly, perceived severity only indirectly shapes COVID-19 vaccination intentions through negative affect. Thirdly, negative affect and response costs are negatively related to COVID-19 vaccination intentions. Finally, Perceived probability, subjective norms, response efficacy and self-efficacy are positively related to COVID-19 vaccination intentions; among them, self-efficacy contributes the most, followed by response efficacy and subjective norms, and lastly perceived probability.

Conclusion

Theoretically, this study increases current understanding about subjective norms and affective responses. We provoke a certain amount of thought about the role of affect response in relation to threat appraisal and vaccination intentions. Specifically, governments must be vigilant that citizens’ negative affect, such as fear, may cause vaccine hesitation.