bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Body Mass Index With Clinical Outcomes in Patients With Heart Failure With Reduced Ejection Fraction Treated With Sacubitril/Valsartan
Authors: Kido Kazuhiko , Bianco Christopher , Caccamo Marco , Fang Wei , Sokos George
Published: June 2021

Background:

Only limited data are available that address the association between body mass index (BMI) and clinical outcomes in patients with heart failure with reduced ejection fraction who are receiving sacubitril/valsartan.

Methods:

We performed a retrospective multi-center cohort study in which we compared 3 body mass index groups (normal, overweight and obese groups) in patients with heart failure with reduced ejection fraction receiving sacubitril/valsartan. The follow-up period was at least 1 year. Propensity score weighting was performed. The primary outcomes were hospitalization for heart failure and all-cause mortality.

Results:

Of the 721 patients in the original cohort, propensity score weighting generated a cohort of 540 patients in 3 groups: normal weight (n = 78), overweight (n = 181), and obese (n = 281). All baseline characteristics were well-balanced between 3 groups after propensity score weighting. Among our results, we found no significant differences in hospitalization for heart failure (normal weight versus overweight: average hazard ratio [AHR] 1.29, 95% confidence interval [CI] = 0.76-2.20, P = 0.35; normal weight versus obese: AHR 1.04, 95% CI = 0.63-1.70, P = 0.88; overweight versus obese groups: AHR 0.81, 95% CI = 0.54-1.20, P = 0.29) or all-cause mortality (normal weight versus overweight: AHR 0.99, 95% CI = 0.59-1.67, P = 0.97; normal weight versus obese: AHR 0.87, 95% CI = 0.53-1.42, P = 0.57; overweight versus obese: AHR 0.87, 95% CI = 0.58-1.32, P = 0.52).

Conclusion:

We identified no significant associations between BMI and clinical outcomes in patients diagnosed with heart failure with a reduced ejection fraction who were treated with sacubitril/valsartan. A large-scale study should be performed to verify these results.
Case Study of Pediatric Cerebral Sinus Venous Thrombosis Center of a Low Middle-Income Country
Authors: Moiz Bushra , Ukrani Ronika Devi , Arif Aiman , Akbar Inaara , Sadiq Muhammed Wahhaab , Altaf Sadaf
Published: June 2021

Pediatric cerebral venous sinus thrombosis (CVST) is rare but a potentially fatal disease requiring its understanding in local setting. In this study, we observed the clinical course, management, and outcome of pediatric patients with sinus thrombosis in a tertiary care center at Pakistan. Patients between age 0 to 18 years of both genders diagnosed with sinus thrombosis during 2011 to 2020 were included. Data was collected through in-house computerized system and SPSS version 19 was used for analysis. Of 143492 pediatric admissions, 32 (21 males and 11 females) patients with a median (IQR) age of 4.5 years (0-16) had CVST. This is equivalent to 18.5 CVST events per million pediatric admissions. Adolescents were mostly affected, and the overall mortality was 7%. Primary underlying disorders were infections (59%), hematological neoplasms (12.5%), thrombotic thrombocytopenic purpura (3%) and antiphospholipid syndrome (3%). Activated protein C resistance (44%) was the most common inherited thrombophilia. Twenty-one (66%) patients were anemic with a mean (±SD) hemoglobin of 9.0 g/dL (±2.3). Regression analysis showed a positive association of anemia with multiple sinus involvement ( P-value 0.009) but not with duration of symptoms ( P-value 0.344), hospital stay ( P-value 0.466), age ( P-value 0.863) or gender ( P-value 0.542) of the patients. SARS-COV2 was negative in patients during 2020. Adolescents were primarily affected by sinus thrombosis and infections was the predominant risk factor for all age groups, with a low all-cause mortality. A high index of clinical suspicion is required for prompt diagnosis and intervention.
Triticale flour in bakery and rusk products
Authors: Leonova Svetlana , Badamshina Elena , Koshchina Elena , Kalugina Olesya , Gareeva Inzira , Leshchenko Nina
Published: June 2021

This paper researches the properties of two triticale varieties and three selection lines developed in Bashkortostan. The organoleptic indicators were typical of a standard grain; all the samples had a high protein content level. Gluten weight ratio matched the grain genotype. The falling number of the studied samples was low. Hydrothermal processing modes for triticale grain before grinding were optimized. The studied varieties and lines were found to yield 65.15%–70.18% of the flour. The conducted polynomial two-factor regression analysis proved that the flour yield factor is the grain softening period lasting 6 h. The dough deformation energy of the obtained flour samples was 67–129 units, the falling number 104–155 s indicates the low baking properties of the flour, thereby it was suggested to make brittle and crisp bakery products as crispbread and breadsticks. A breadstick formula with 60% wheat flour replaced with triticale flour was developed. The number of spore Rope bacteria increased slightly during the shelf life but did not exceed the permissible values. There have been developed formulas and methods to make crispbreads for producing crackers with triticale bran of 40% have been developed.
The Association of Oral Stimulant Medication Adherence with Work Productivity among Adults with ADHD
Authors: Spalding William , Farahbakhshian Sepehr , Maculaitis Martine C. , Peck Eugenia Y. , Goren Amir
Published: June 2021

Objective:

Examine associations between oral psychostimulant pharmacotherapy adherence, work productivity, and related indirect costs among US adults with ADHD.

Methods:

Medication adherence (Medication Adherence Reasons Scale [MAR-Scale]), work productivity and activity impairment (Work Productivity and Activity Impairment–General Health questionnaire), and ADHD symptom level (Adult ADHD Self-Report Scale version 1.1 Symptom Checklist) were assessed in this noninterventional online survey of adults who self-reported having an ADHD diagnosis and were currently receiving oral psychostimulant treatment for ≥3 months.

Results:

Of 602 respondents, 395 had low/medium adherence (LMA: MAR-Scale total score ≥1) and 207 had high adherence (HA: MAR-Scale total score 0). After adjusting for covariates, the LMA group had significantly greater levels of absenteeism, absenteeism-related indirect costs, and total indirect costs (all p < .01) than the HA group.

Conclusion:

In adults with ADHD using oral psychostimulants, lower medication adherence was associated with greater absenteeism and indirect costs.
Total hip arthroplasty in hereditary multiple exostosis patients: literature review and evaluation of 10 cases
Authors: Ostetto Federico , Lana Debora , Tuzzato Gianmarco , Staals Eric , Donati Davide M , Bianchi Giuseppe
Published: June 2021

Background:

Acquired hip deformities in patients affected by hereditary multiple exostosis (HME) may incur in early hip osteoarthritis and functional limitation requiring primary total hip arthroplasty (THA). Characteristic coxo-femoral joint dysmorphisms in HME may pose a challenge for the orthopaedic surgeon. Here we report our experience in a series of patients with HME treated in our hospital with THA.

Methods:

With a mean follow-up of 5 years, 10 primary THAs were reviewed; proximal femur deformities, acetabular dysplasia and joint osteoarthritis has been assessed through x-rays and CT-scan evaluation. In all cases hemispheric press-fit cups were used; 4 stem had metaphyseal engagement, 5 had proximal diaphyseal engagement and 1, with anatomical geometry, had metaphyseal fixation. 2 cases required stem cementation, 3 modular neck and 1 lateralised. The clinical data, complications and clinical outcomes, were recorded and analysed.

Results:

The mean Harris Hip Score (HHS) increased from 34 preoperative to 86 postoperative; preoperative mean neck shaft angle (NSA) was 150°, head/neck ratio 0.6, offset 31 mm; Wiberg angle 28°, Sharp angle 38°, 1 patient had subluxation grade 4 according to Crowe, 8 hips showed osteoarthritis (Tönnis grade ⩾2 ); 5 femurs were classified as Dorr type C, 2 as type B and 3 as type A. Perioperative complications were not observed.

Conclusions:

Primary THA in HME significantly improved clinical and functional outcomes. Press-fit cup fixation together with metaphyseal and proximal diaphyseal stem engagement on reliable bone quality femur, represents a valid option in HME patients with normal acetabular morphology, wide broaden neck and valgus NSA.
Subcutaneously anchored securement for peripherally inserted central catheters: Immediate, early, and late complications
Authors: Brescia Fabrizio , Pittiruti Mauro , Roveredo Laura , Zanier Chiara , Morabito Antonietta , Santarossa Elisabetta , Da Ros Valentina , Montico Marcella , Fabiani Fabio
Published: June 2021

Background:

An adequate stabilization of a vascular device is an important part of insertion bundles and is an effective strategy in reducing complications. Dislodgment has a relevant clinical impact and an increase in healthcare costs.

Method:

We have retrospectively investigated the safety and efficacy of Subcutaneously Anchored Securement (SAS) for Peripherally Inserted Central Catheters (PICC) in cancer patients.

Results:

We analyzed 639 patients who had a PICC inserted and secured with SAS, over the past 3 years (2018–2020). No immediate complications during SAS placement were reported. In the first 24–48 h, a slight local ecchymosis was reported in 24 cases with rapid spontaneous resolution. No cases of bleeding or hematoma of the exit site were reported. The total number of catheter days was 93078. Dislodgment occurred only in seven cases (1.1%). In 16 patients, the PICC was removed because of catheter-related bloodstream infection (CRBSI): the overall incidence of CRBSI was 0.17 per 1000 catheter days. Symptomatic venous thrombosis was documented in 12 patients (1.9%) and treated with low molecular weight heparin without PICC removal. We had no cases of irreversible lumen occlusion. In 17 patients, local discomfort—including device-related pressure ulcers and painful inflammation—was reported: these cases were treated without SAS removal or PICC removal.

Conclusion:

In this retrospective analysis, subcutaneously anchored securement of PICCs was a safe and effective strategy for reducing the risk of dislodgment.
Qualitative Assessment of the Quality of Care for Preterm, Low Birth Weight, and Sick Newborns in Ethiopia
Authors: Jebessa Solomie , Litch James A , Senturia Kirsten , Hailu Tedros , Kahsay Amaha , Kuti Kemal A , Wolka Eskinder , Teklu Alula M , Gezahegn Wendemaghen
Published: June 2021

This study assesses the quality of care for preterm, low birth weight (LBW), and sick newborns across the public health care system levels in 3 regions of Ethiopia. Qualitative data based on the WHO framework to assess provision and experience of care was collected using in-depth interviews and focus group discussions with women who recently delivered preterm, LBW, and sick newborns, as well as health care providers and health extension workers, and facility administrators associated with study health facilities. This qualitative approach revealed perspectives of patients, health care providers and facility administrators to assess what is actually happening in facilities. Clinical guidelines for the care of preterm, LBW, and sick newborns were not available in many facilities, and even when available, often not followed. Most providers reported little or no communication with parents following hospital discharge. Human resource challenges (shortage of skilled staff, motivation and willingness, lack of supervision, and poor leadership) inhibited quality of care. Participants reported widespread shortages of equipment and supplies, medication, physical space, water, electricity, and infrastructure. Economic insecurity was a critical factor affecting parents’ experience. Acceptance by users was impacted by the perceived benefits and cost. Users reported they were less likely to accept interventions if they perceived that there would be financial costs they couldn’t afford. The quality of care for preterm, LBW, and sick newborns in Ethiopia as reported by recently delivered women, health care providers and facility administrators is compromised. Improving quality of care requires attention to process of care, experience of care, and health system capacity, structure, and resources.
‘Whose were those feelings?’ Affect and likenessing in Halat hisar live action role-playing game
Authors: Pöllänen Sonja , Arjoranta Jonne
Published: June 2021

Halat hisar was a live action role-playing game (larp) organized in Finland in 2016. Halat hisar’s ambition as a larp was to mirror the current situation in Palestine. In larps, participants take on different roles and improvise without the presence of an audience. Larps offer a place where emotions and affectivities are transmitted through the embodiment of characters. Larps offer forms of likenessing, which create new affective states for the players. We conclude that larps can be powerful tools for portraying political alternatives of actual events, and they can serve a role in raising awareness. Larps offer a productive context for studying subjectivities where the focus is on affective relationalities because larps place the participants in social positions where they take up roles that might be inaccessible to them in everyday life. Larps offer a window to visit other ‘world-lines’ – and other ways of living.
Alcohol in long-term care homes: A qualitative investigation with residents, relatives, care workers and managers
Authors: Emiliussen Jakob , Engelsen Søren , Christiansen Regina , Nielsen Anette Søgaard , Klausen Søren Harnow
Published: June 2021

Introduction:

Western societies are aging rapidly, and habitual use of alcohol is changing among older adults. Hence, care facilities are facing novel challenges regarding alcohol use. This pioneering qualitative study seeks to investigate the role of alcohol in care homes, as seen from the perspectives of residents, care workers, relatives, and institution management simultaneously.

Method:

Five residents, four care workers, three relatives, and two care home managers participated in semi-structured interviews lasting 60 minutes maximum. An interpretative phenomenological analysis framework were utilised for the analysis.

Results:

It seems that there is a positive attitude towards the use of alcohol in care homes across the four groups of participants. They find that the use of alcohol is presently low among the residents. Importantly there appears to be an important symbolic value in the rituals surrounding alcohol which is upheld by all four groups.

Conclusion:

While experiences between the four groups seem to converge regarding the use of alcohol, there are still some important differences. Importantly, we suggest that these unique views be utilised in developing methods for handling alcohol use in care homes in the future.
Memes, scenes and #ELXN2019s: How partisans make memes during elections
Authors: McKelvey Fenwick , DeJong Scott , Frenzel Janna
Published: June 2021

Our article analyses partisan, user-generated Facebook pages and groups to understand the articulation of political identity and party identification. Adapting the concept of scenes usually found in music studies, these Facebook pages and groups act as partisan scenes that maintain identities and sentiments through participatory practices, principally by making and sharing memes. Using a mixed methods approach that combines social media data and interviews during the 2019 Canadian federal election, we find that these partisan scenes are an active part of elections and the overall political information cycle in Canada but endure beyond election cycles. Rather than trying to sway voters of different political affiliation and influence the election outcome, Facebook users employ memes to hang-out and build community, thereby reinforcing partisanship.
Impedance eduction for uniform and multizone acoustic liners
Authors: Jones Michael G , Nark Douglas M , Howerton Brian M
Published: June 2021

This paper presents results for five uniform and two multizone liners based on data acquired in the NASA Langley Grazing Flow Impedance Tube. Two methods, Prony and CHE, are used to educe the impedance spectra for each of these liners for many test conditions. The Prony method is efficient and generally provides accurate results for uniform liners, but is not well suited for multizone liners. The CHE method supports assessment of both uniform and multizone liners, but is much more computationally expensive. The results from these liners demonstrate the efficacy of both eduction methods, but also clearly demonstrate that sufficient attenuation is required to support accurate impedance eduction. For the liners considered in this study, the data indicate approximately 3 dB attenuation is needed for each zone of a multizone liner in order to ensure quality impedance eduction results. This study was conducted in response to two acoustic liner research challenges in support of a collaboration of multiple national laboratories under the International Forum for Aviation Research.
Defect detection on the curved surface of a wind turbine blade using piezoelectric flexible line sensors
Authors: Kang Sang-Hyeon , Kang Myeongcheol , Kang Lae-Hyong
Published: June 2021

Blades play a critical role in the wind turbine system. Therefore, their structural health monitoring is very important. Blades are damaged by sudden changes in wind load, cracks due to collision of foreign objects, and disasters, such as lightning strikes, hail, and typhoons. Moreover, blades are expensive to maintain. Defects or damages to wind turbine blades reduce the life span and power generation efficiency of the wind turbine and increase safety risks and maintenance costs. Therefore, it is very important to detect blade damage to prevent problems in the wind turbine. Ultrasonic inspection is suitable for blades made of composite materials. Piezoelectric ceramic, which is a typical piezoelectric element, has relatively high sensitivity compared to other sensors. However, it suffers from brittle fractures and thus difficult to apply to curved structures. To overcome the limitations of piezoelectric ceramics, a piezoelectric flexible line sensor that can be applied to curved surfaces was manufactured using the dice-and-fill method for a [Pb(Li0.25Nb0.75)]0.06 [Pb(Mg0.33Nb0.67)]0.06 [Pb(Zr0.50Ti0.50)]0.88O3 with 0.7 wt% MnO2 (PZTNMML) ceramic disc. Instead of a typical ultrasonic inspection method with limited surface contact, a laser capable of producing ultrasonic excitation of ultrasonic waves over a large area from a long distance was used. The possibility of detecting a defect on the wind turbine blade using a piezoelectric flexible line sensor and laser ultrasound was confirmed in this study.
Labour Input Logic of Street-Level Bureaucrats: Evidence from Chinese Market Supervision Commission
Authors: Li Chunna , Yang Jun
Published: June 2021

The theory of street-level bureaucracy and its relevant data have proven the expected duties of the frontline staff of local government may be excessive but their time spent working remains quite low. Using data from participatory observations of street-level officials in a Chinese city, this study reveals the logic of this labour input paradox. Organizational climate incentive and promotional incentive jointly influence the time allocation of street-level bureaucrats. The organizational climate incentive reflects the weak incentive characteristic of the maintenance function of labour; promotional incentives have a strong impact on motivation, which is characteristic of the promotional function of labour. These findings reveal the costs of the New Public Management movement in an organization lacking an effective promotion mechanism and a positive organizational climate incentive. This is a snapshot of the dilemma faced by China’s public organization reforms, but it is also a problem other country must solve.
Intravascular Ultrasound in Branched and Fenestrated Endovascular Aneurysm Repair: Initial Experience in a Single-Center Cohort Study
Authors: Gennai Stefano , Leone Nicola , Saitta Giuseppe , Migliari Mattia , Lauricella Antonio , Farchioni Luca , Silingardi Roberto
Published: June 2021

Purpose:

To evaluate intravascular ultrasound (IVUS) safety and efficacy to detect visceral stenting issues during complex endovascular aneurysm repair through branched and fenestrated repair (B-FEVAR).

Materials and Methods:

A single-center retrospective analysis of 33 bridging stents assessed intraoperatively using IVUS between January and September 2020 was performed. Ten aortic aneurysm patients [7 thoracoabdominal / 1 pararenal / 2 juxtarenal; 3 females; mean age 73 years [range 70–77 years]) were included. Eight BEVAR (5 standard; 2 custom-made) and 2 FEVAR (custom-made) were performed. The study assessed the safety and efficacy of IVUS utilization to detect immediate branch instability after visceral stenting in the case of B-FEVAR. The primary safety endpoint was defined as the absence of IVUS-related adverse events. The primary efficacy endpoint was defined as the composite of technical success of the IVUS-assessment in each target visceral vessels (TVVs), the rate of IVUS-findings divided as prompting additional maneuvers or not, and the incidence of postoperative computed tomography angiography findings compared with intraoperative assessment.

Results:

There were no IVUS-related adverse events. The technical success of the IVUS-assessment was achieved in all TVVs. No technical issues compromised the evaluation of the intended vessel. Among the 7 findings identified by IVUS, 3 were suspected at the angiography. In all, 57% (4/7) had normal final angiography. IVUS was able to detect a 12% (4/33) intraoperative branch instability not identified/suspected at the completion angiography. The IVUS assessment led to an immediate revision in 5 (15%) vessels. A total of 57% (4/7) of the issues were detected in patients undergoing primary BEVAR. The remaining 43% (3/7) was detected in patients undergoing secondary intervention for branch instability.

Conclusion:

IVUS was safe as an adjunctive imaging technique to assess completion after B-FEVAR. It demonstrated efficacy in the detection of intraoperative issues missed by angiography. Further investigations are required to validate these promising results.
Contemporary Results of Carotid Artery Stenting Using Low-Profile Dual-Metal Layer Nitinol Micromesh Stents in Relation to Single-Layer Carotid Stents
Authors: Kahlberg Andrea , Bilman Victor , Ardita Vincenzo , Mascia Daniele , Bertoglio Luca , Rinaldi Enrico , Melissano Germano , Chiesa Roberto
Published: June 2021

Purpose:

To evaluate patients characteristics, procedural details, perioperative outcomes, and midterm results of carotid artery stenting (CAS) performed with the Roadsaver/Casper stent (Terumo Corp, Tokyo, Japan) as compared to concurrent patients treated with other commercially available carotid stents.

Materials and Methods:

This is a single-center, retrospective, nonrandomized study including 200 consecutive patients who underwent a total of 205 elective CAS procedures due to severe internal carotid artery stenosis between April 2015 and December 2018. Procedural data and outcomes for patients treated with the Roadsaver/Casper stent implantation (100 procedures, in 97 patients) vs first-generation carotid stents implantations (90 procedures, in 88 patients) were compared. Fifteen patients were treated with CGuard carotid stent (InspireMD, Tel Aviv, Israel), and outcomes were reported separately. Primary endpoints were the occurrence of major adverse cerebrovascular events (MACE), including death, ipsilateral stroke, and transitory ischemic attack (TIA). Secondary endpoints were the rate of intrastent stenosis, the need for reintervention, and the occurrence of adverse cardiovascular events, including myocardial infarction, arrhythmias, and need for inotropic support.

Results:

No difference in demographics and preoperative risk factors were observed between patients treated with and without the Roadsaver/Casper stent. The mean procedure time was shorter in the Roadsaver/Casper group (40.7±16.9 vs 49.4±27.3 minutes; p=0.008), while radial percutaneous access was more frequent (24% vs 5%; p<0.001). The rate of stroke/TIA/death at 30 days was 3% in the Roadsaver group vs 1% in the first-generation stent group (p=0.623). The primary patencyrate was 100% and 93.4% at 1- and 3-year of follow-up in the Roadsaver/Casper groupand 99% and 94.3% in the other stent group, respectively (p=0.95).

Conclusions:

In this real-world cohort of patients undergoing CAS, the Roadsaver/Casper stent was used to treat more symptomatic and vulnerable carotid plaques as compared to other carotid stents. Nevertheless, patients treated with this low-profile dual-layer micromesh stent showed low events rates at both 30 days and follow-up, similar to that observed for other stents.
Shared Christian Religious Identity, Religiousness, and Marital Satisfaction
Authors: Fraser Ryan N. , Dalton James H. , Burkhart Jeremiah W. , Collins Jared T.
Published: June 2021

This study investigates whether shared Christian religious identity between spouses, individual/shared religiousness, and satisfaction with that religiousness affects individual and marital satisfaction. Research participants ( N = 568) completed psychometric measures to report: individual wellbeing, emotional intimacy as a couple, satisfaction with sexual intimacy as a couple, and overall marital satisfaction. Results indicated shared religious identity was correlated with higher marital satisfaction. Generally, higher levels of religiousness were correlated with higher scores on the outcome measures. Finally, participants’ satisfaction with their individual and shared religiousness was significantly correlated with higher scores on the selected outcome measures.
Effect of Transcutaneous Electrical Stimulation in Chronic Poststroke Patients with Oropharyngeal Dysphagia: 1-Year Results of a Randomized Controlled Trial
Authors: Arreola Viridiana , Ortega Omar , Álvarez-Berdugo Daniel , Rofes Laia , Tomsen Noemí , Cabib Christopher , Muriana Desiree , Palomera Elisabet , Clavé Pere
Published: June 2021

Background. Chronic poststroke oropharyngeal dysphagia (CPSOD) is associated with impaired oropharyngeal sensory/motor function. We aimed to assess effect of sensory (SES) and motor (NMES) transcutaneous electrical stimulation (TES) on safety of swallow and clinical outcomes in patients with CPSOD in a one-year follow-up randomized controlled trial. Methods. Ninety patients (74.1 ± 11.5 y, modified Rankin score 2.6 ± 1.7) with CPSOD and impaired safety of swallow were randomized to (a) compensatory treatment (CT), (b) CT + SES, and (c) CT + NMES. Patients were treated with up to two cycles (6 months apart) of 15 × 1 hour TES sessions over two weeks and followed up with 4-5 clinical and videofluoroscopic assessments during one year. Key results. Baseline penetration–aspiration scale (PAS) was 4.61 ± 1.75, delayed time to laryngeal vestibule closure (LVC) 396.4 ± 108.7 ms, and impaired efficacy signs 94.25%. Swallowing parameters significantly improved between baseline and 1-year follow-up in SES and NMES groups for prevalence of patients with a safe swallow ( P < .001), mean PAS ( P < .001), time to LVC ( P < .01), and need for thickening agents ( P < .001). Patients in the CT presented a less intense improvement of signs of impaired safety of swallow without significant changes in time to LVC. No differences between groups were observed for 1-year mortality (6.1%), respiratory infections (9.6%), nutritional and functional status, QoL, and hospital readmission rates (27.6%). No significant adverse events related to TES were observed. Conclusions and inferences. Transcutaneous electrical stimulation is a safe and effective therapy for older patients with CPSOD. After 1-year follow-up, TES greatly improved the safety of swallow and reduced the need for fluid thickening in these patients.
Trends in Early Discharge and Associated Costs after Transcatheter Aortic Valve Replacement: A National Perspective
Authors: Okoh Alexis K. , Siddiqui Emaad , Soto Cassandra , Dhaduk Nehal , Hirji Sameer , Tayal Rajiv , Chen Chunguang , Lee Leonard Y. , Russo Mark J.
Published: June 2021

Objective

The current study aims to report trends of early discharges and identify associated direct costs using a nationally representative database of real-world data experience.

Methods

We used nationally weighted data on all patients who had transfemoral transcatheter aortic valve replacement (TAVR) from 2012 to 2017 and discharged alive from the National Inpatient Sample. Patients were divided into early (discharge ≤3 days of admission) and late discharge. Demographics and clinical characteristics were compared. Trends in early discharge and costs associated with admissions were analyzed over the study period.

Results

Of the 125,188 patients identified, 59,424 (46.9%) were discharged early. The proportion of early discharge increased from 15% in early 2012 to 68% in late 2017 ( P < 0.001), with the largest increase occurring from 2014 to 2015. Overall, the average cost of TAVR decreased from $58,408 in 2012 to $49,875 in 2017 ( P < 0.001). Compared to late discharge, patients discharged early reported costs savings of ≥$20,000 over the study period. Among the early discharge group, no significant differences in costs were observed for patients discharged on 0 to 1, 2, or 3 days after the procedure.

Conclusions

Postoperative length of stay after TAVR has decreased dramatically within the last decade with an observed reduction in procedural costs. While discharge within 3 days appeared cost effective, no differences in costs were noted among patients discharged ≤3 days.
Knowledge into action: proposing an evidence-based group prenatal exercise prescription
Authors: Sánchez-Polán M , Nagpal TS , Barakat R
Published: June 2021

Aims:

In accordance with the American College of Obstetricians and Gynaecologists recommendations for exercise during pregnancy, this article provides an evidence-based prescription for a group-based prenatal exercise programme.

Methods:

This prescription has been tested in 21 randomized controlled trials. This short report outlines in detail the seven components included in each session (warm-up, aerobic training, resistance training, coordination and balance, pelvic floor training, cool-down, and final discussion).

Results:

Using the 26-item behaviour change taxonomy proposed by Abraham and Michie, we identified common techniques that are employed in each session to provide a rationale for the high-programme adherence.

Conclusions:

This session model can be replicated to design prenatal exercise programmes with high adherence and that can be offered by trained exercise professionals.
Changes in Personal Values in Pandemic Times
Authors: Daniel Ella , Bardi Anat , Fischer Ronald , Benish-Weisman Maya , Lee Julie A.
Published: June 2021

The COVID-19 pandemic has had immense impact on people’s lives, potentially leading individuals to reevaluate what they prioritize in life (i.e., their values). We report longitudinal data from Australians 3 years prior to the pandemic, at pandemic onset (April 2020, N = 2,321), and in November–December 2020 ( n = 1,442). While all higher order values were stable prior to the pandemic, conservation values, emphasizing order and stability, became more important during the pandemic. In contrast, openness to change values, emphasizing self-direction and stimulation, showed a decrease during the pandemic, which was reversed in late 2020. Self-transcendence values, emphasizing care for close others, society, and nature, decreased by late 2020. These changes were amplified among individuals worrying about the pandemic. The results support psychological theory of values as usually stable, but also an adaptive system that responds to significant changes in environmental conditions. They also test a new mechanism for value change, worry.
Effectiveness of caregiver interventions for people with cancer and non-cancer-related chronic pain: a systematic review and meta-analysis
Authors: Smith Toby O. , Pearson Matthew , Smith Matthew J , Fletcher Jessica , Irving Lisa , Lister Sarah
Published: June 2021

Background:

People with chronic pain frequently have difficulties in completing everyday tasks to maintain independence and quality of life. Informal caregivers may provide support to these individuals. However, the effectiveness of interventions to train and support these individuals in caregiving remains unclear. The purpose of this study was to systematically review the evidence to determine the effectiveness of caregiver interventions to support informal caregivers of people with chronic pain.

Methods:

A systematic review of published and unpublished literature databases was undertaken (9 April 2021). Trials reporting clinical outcomes of caregiver interventions to train informal caregivers to support community-dwelling people with chronic pain were included. Meta-analysis was undertaken and each outcome was assessed using Grading of Recommendations, Assessment, Development and Evaluation.

Results:

Twenty-seven studies were eligible (N = 3427 patients). Twenty-four studies assessed patients with cancer pain and three with musculoskeletal pain. No other patient groups were identified. There was very low-quality evidence that caregiver interventions were beneficial for caregiver health-related quality of life (standardised mean difference = 0.26, 95% confidence interval = 0.01 to 0.52; N = 231). There was moderate-quality evidence that caregiving interventions were effective in reducing pain in the short-term (standardised mean difference = 0.16, 95% confidence interval = −0.29 to −0.03). There was low-quality evidence that caregiving interventions had no beneficial effect over usual care for psychological outcomes, fatigue, coping or physical function in the long-term.

Conclusion:

Caregiving interventions may be effective for patients and caregivers but only in the shorter-term and for a limited number of outcomes. There is insufficient evidence examining the effectiveness of caregiver interventions for people with non-cancer-related pain.
Visual media analysis for Instagram and other online platforms
Authors: Rogers Richard
Published: June 2021

Instagram is currently the social media platform most associated with online images (and their analysis), but images from other platforms also can be collected and grouped, arrayed by similarity, stacked, matched, stained, labelled, depicted as network, placed side by side and otherwise analytically displayed. In the following, the initial focus is on Instagram, together with certain schools of thought such as Instagramism and Instagrammatics for its aesthetic and visual cultural study. Building on those two approaches, it subsequently focuses on other web and social media platforms, such as Google Image Search, Twitter, Facebook and 4chan. It provides demonstrations of how querying techniques create online image collections, and how these sets are analytically grouped through arrangements collectively referred to as metapictures.
Algorithms as organizational figuration: The sociotechnical arrangements of a fintech start-up
Authors: Dahlman Sara , Gulbrandsen Ib T , Just Sine N
Published: June 2021

Building on critical approaches that understand algorithms in terms of communication, culture and organization, this paper offers the supplementary conceptualization of algorithms as organizational figuration, defined as material and meaningful sociotechnical arrangements that develop in spatiotemporal processes and are shaped by multiple enactments of affordance–agency relations. We develop this conceptualization through a case study of a Danish fintech start-up that uses machine learning to create opportunities for sustainable pensions investments. By way of ethnographic and literary methodology, we provide an in-depth analysis of the dynamic trajectory in and through which the organization gives shape to and takes shape from its key algorithmic tool, mapping the shifting sociotechnical arrangements of the start-up, from its initial search for a viable business model through the development of the algorithm to the public launch of its product. On this basis, we argue that conceptualizing algorithms as organizational figuration enables us to detail not only what algorithms do but also what they are.
Research-Informed Adaptable Model for the Prevention of Suicide in Schools (RAMPSS)
Authors: McFarlin Shannon Lynch , McGough Kimberly
Published: June 2021

With increased suicide rates among youth during recent decades, the K–12 educational community still lacks a comprehensive model for suicide prevention that is tailorable for school systems. With this article, we present the Research-Informed Adaptable Model for the Prevention of Suicide in Schools (RAMPSS). A multitiered system of support, RAMPSS includes (a) all four major components of the American School Counselor Association National Model and (b) options for research-based responsive services at each tier level.
Rural-Urban Differences in Caregiver Burden Due to the COVID-19 Pandemic among a National Sample of Informal Caregivers
Authors: Cohen Steven A. , Kunicki Zachary J. , Nash Caitlin C. , Drohan Megan M. , Greaney Mary L.
Published: June 2021

The objective of this exploratory study was to explore potential associations between changes to caregiver burden (CB) due to the COVID-19 pandemic and rural-urban status using a nationally representative sample of 761 informal caregivers. Tertiles of two measures of rural-urban status were used: Rural-Urban Commuting Areas (RUCAs) and population density. Bivariate and multivariable binary and ordinal logistic regression were used to asses study objectives. Using RUCAs, rural informal caregivers were more than twice as likely as urban informal caregivers to report a substantial increase in CB due to COVID-19 (OR 2.27, 95% CI [1.28–4.02]). Similar results were observed for population density tertiles (OR 2.20, 95% CI [1.22–3.96]). Having a COVID-19 diagnosis was also significantly associated with increased CB. Understanding and addressing the root causes of rural-urban disparities in CB among informal caregivers is critical to improving caregiver health and maintaining this critical component of the healthcare system.
Determinants of Neonatal Sepsis among Neonates Admitted to Public Hospitals in Central Ethiopia: Unmatched Case-control Study
Authors: Bulto Gizachew Abdissa , Fekene Daniel Belema , Woldeyes Benyam Seifu , Debelo Bikila Tefera
Published: June 2021

Background. Neonatal sepsis is the cause of substantial morbidity and mortality, mostly affecting the developing countries including Ethiopia. Previously conducted studies also highlighted the high prevalence of neonatal sepsis in Ethiopia. Therefore, this study was aimed at assessing the determinants of neonatal sepsis in the central Ethiopia. Method. Institution based un-matched case control study was conducted among 192 cases (neonates with sepsis) and 384 controls (without sepsis) in public hospitals in Central Ethiopia. The data were collected through face-to-face interview using structured questionnaire and extraction from maternal and neonatal charts. Binary logistic regression (bi-variable and multi-variable) model was fitted. Adjusted odds ratio with respect to 95% confidence interval was employed for the strength and directions of the association. Results. Younger maternal-age; 30 to 34 years (AOR = 0.41, 95%CI: 0.19-0.85) and 25 to 29 years (AOR = 0.38, 95%CI: 0.17-0.84), not having antenatal care (ANC) follow-ups (AOR = 1.89, 95%CI: 1.02-3.49), place of delivery; home (AOR = 12.6, 95%CI: 5.32-29.82) and health center (AOR = 2.74, 95%CI: 1.7, 4.41), prolonged duration of labor (AOR = 1.90, 95%CI: 1.22, 2.96), prolonged rupture of membrane 12 to 17 hours (AOR = 3.26, 95%CI: 1.46, 7.26) and ≥18 hours (AOR = 5.18, 95%CI: 1.98, 13.55) were maternal related determinants of neonatal sepsis. Whereas, prematurity (AOR = 2.74, 95%CI: 1.73, 4.36), being resuscitated (AOR = 1.93, 95%CI: 1.22, 3.06) and not having meconium aspiration syndrome (AOR = 2.55, 95%CI: 1.34, 4.83) were identified as neonatal related determinants of neonatal sepsis. Conclusion. Younger maternal age, not having antenatal care follow-up, home, and health center delivery, prolonged duration of labor, prolonged duration of rupture of membrane, prematurity, had resuscitation, and neonates without meconium aspiration syndrome were found to be determinants of neonatal sepsis. Therefore, the concerned stakeholders should consider those identified determinants during an intervention for improvement of neonatal health.
“Hay que Cantar con Ternura”: Baladas Románticas as a Site for Translingual Youth Convivencia
Authors: de los Ríos Cati V. , Portillo Yared
Published: June 2021

For many Mexican-origin bi/multilingual children, Mexican music education begins early in their home. Music is inextricably linked with the sociocultural context in which it is produced, consumed, and taught and the interrelationship between music, society, and culture. Using ethnographic methods, this article examines a small group of bilingual and emergent bilingual Mexican-origin students who regularly congregated in their English teacher’s classroom at lunchtime to recite and perform romance ballads, or what we refer to as baladas románticas, on a weekly basis. We use participant observation, plática-inspired interviews, focus groups, and video recordings to present ethnographic knowledge about how, for these young people, music was a way of being and a deliberate act to build community. Our findings describe the ways the bilingual students found themselves at the margins of their K–12 schooling experiences and, in turn, agentically fostered their own space for translingual expression and solace. This manifested in two primary ways: (a) how they collectively fostered their own form of convivencia (humanizing coexistence) anchored in their ancestral and cultural knowledge through their music-making and (b) how their music-making allowed them to release translingual and transmodal play and creativity that might have otherwise been suppressed at school. We end with a call for literacy researchers and educators to continue to recognize and honor students’ lived translingual experiences, identities, and musical gifts as resources for learning.
Assessing the Merits of a PPI Trial-Based Diagnosis for Gastroesophageal Reflux Disease: Speculations on Efficacy and Pitfalls
Authors: Kamal Afrin N. , Zikos Thomas A. , Clarke John O.
Published: June 2021

Gastroesophageal reflux disease is a highly prevalent condition which can lead to complications in affected individuals. Given the economic implications of widespread testing, there has been interest in a symptom-based approach to diagnosis and use of short-term empiric acid suppressive therapy as a diagnostic modality. This review will highlight the background with regards to these clinical questions, the data regarding performance characteristics of establishing a symptom-based reflux diagnosis (focusing on typical, atypical, and extra-esophageal symptoms), the merits of the so-called “PPI Trial” and potential pitfalls to consider when seeing patients with suspected reflux symptoms.
Practical Approach to Refractory GERD: GI Perspective over the Last 40 Years
Authors: Richter Joel E.
Published: June 2021

Refractory GERD patients not responding to BID proton pump inhibitors are often referred for anti-reflux surgery. Over the last 40 years, I have learned the importance of a team approach with comprehensive esophageal testing to appropriately find the patients who will benefit from surgery. All patients need upper endoscopy, high-resolution manometry and prolonged pH testing. Selected patients may need a barium esophagram or gastric emptying testing. All complex cases are discussed at our weekly esophageal conference which includes gastroenterologists, foregut surgeons and swallowing therapists. Ten case scenarios are presented of recurrent themes in patients with “refractory” GERD, many whom don’t have acid reflux.
ERS clinical practice guidelines on treatment of sarcoidosis
Authors: Baughman Robert P. , Valeyre Dominique , Korsten Peter , Mathioudakis Alexander G. , Wuyts Wim A. , Wells Athol , Rottoli Paola , Nunes Hiliaro , Lower Elyse E. , Judson Marc A. , Israel-Biet Dominique , Grutters Jan C. , Drent Marjolein , Culver Daniel A. , Bonella Francesco , Antoniou Katerina , Martone Filippo , Quadder Bernd , Spitzer Ginger , Nagavci Blin , Tonia Thomy , Rigau David , Ouellette Daniel R.
Published: June 2021

Background

The major reasons to treat sarcoidosis are to lower the morbidity and mortality risk or to improve quality of life (QoL). The indication for treatment varies depending on which manifestation is the cause of symptoms: lungs, heart, brain, skin or other manifestations. While glucocorticoids remain the first choice for initial treatment of symptomatic disease, prolonged use is associated with significant toxicity. Glucocorticoid-sparing alternatives are available. The presented treatment guidelines aim to provide guidance to physicians treating the very heterogenous sarcoidosis manifestations.

Methods

A European Respiratory Society Task Force committee composed of clinicians, methodologists and patients with experience in sarcoidosis developed recommendations based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) methodology. The committee developed eight PICO (Patients, Intervention, Comparison, Outcomes) questions and these were used to make specific evidence-based recommendations.

Results

The Task Force committee delivered 12 recommendations for seven PICOs. These included treatment of pulmonary, cutaneous, cardiac and neurologic disease as well as fatigue. One PICO question regarding small-fibre neuropathy had insufficient evidence to support a recommendation. In addition to the recommendations, the committee provided information on how they use alternative treatments, when there was insufficient evidence to support a recommendation.

Conclusions

There are many treatments available to treat sarcoidosis. Given the diverse nature of the disease, treatment decisions require an assessment of organ involvement, risk for significant morbidity, and impact on QoL of the disease and treatment.