bluuebunny/crossref_metadata_2025 huggingface dataset:
Experiences of nurses managing parenthood and career: A systematic review and meta‐synthesis
Authors: Ong Pearl , Cong Xiaomei , Yeo Yumi , Shorey Shefaly
Published: September 2023

Aim

Consolidate and synthesize evidence on working nurse‐parent experiences of parenthood.

Background

Demands in healthcare strain the workforce, causing burnout and high turnover rates, especially among nurses. Balancing work and family responsibilites is even more challenging for nurse‐parents.

Introduction

Nursing is highly stressful, and the experiences of nurse‐parents are under‐researched highlighting the need to better understand and support nurse‐parents in their dual roles.

Methods

Seven databases (PubMed, Embase, CINAHL, PsycINFO, ProQuest, Scopus, and Web of Science) were systematically searched for published and unpublished primary qualitative studies. Extracted data were meta‐summarized and synthesized using Sandelowski and Barroso's approach.

Findings

Twelve peer‐reviewed studies, conducted between 2007 and 2022, investigated the challenges faced by 339 female nurse‐parents across various countries. The meta‐synthesis revealed two main themes: (a) Clashes of dual roles, and (b) Accept, adapt, and compromise, which were supported by six subthemes. Nurse‐parents struggled with dual roles, often neglected self‐care, and experienced work–family conflicts. However, they learned to accept their situations, adapt by seeking help from family, friends, and colleagues, and compromise on career aspirations to prioritize their families. The importance of organizational support and flexibility in accommodating their dual roles was emphasized.

Discussion

Female nurse‐parents face challenges in balancing their dual roles, resulting in fatigue, compromised self‐care, and limited social interactions. The culture of self‐sacrifice in nursing contributes to these challenges, impacting patient safety. Supportive interventions like mindfulness programs and exercise classes can promote well‐being. Staffing shortages and shift work further affect the work–life balance for nurse‐parents.

Conclusion and implications for nursing and health policy

Creating a supportive work environment for nurse‐parents is crucial. Family‐friendly shifts revised parental leave policies, and improved childcare support are needed. Supporting nurse‐parents benefits their well‐being and enhances patient care. Collaboration between healthcare organizations and policymakers is essential to address workforce shortages and implement changes.
The effects of perceived organizational support on attitudes toward medical errors in surgical nurses: A cross‐sectional study
Authors: Er Fatma , Özkan Meral
Published: September 2023

Aim

This study aims to determine the effects of perceived organizational support on attitudes toward medical errors in surgical nurses.

Background

Nurses exhibit high performance in a work environment that supports, satisfies, and motivates them. Organizational support is one of the factors affecting the work environments of nurses. A strong nursing and hospital leadership supports the daily professional practices and well‐being of nurses and is important in creating a positive work environment for nurses.

Materials and methods

The population of this cross‐sectional study was composed of nurses (N = 414) in the surgical clinics of the Turgut Özal Medical Center. To reach the necessary sample size, the purposive sampling method, which is a nonprobability sampling method, was used. The data were collected using a personal information form, the Perceived Organizational Support Scale and the Scale of Attitudes toward Medical Errors.

Results

It was determined that 91.1% of the participants had positive attitudes toward the importance and reporting of medical errors and moderate perceived organizational support (3.04 ± 0.67). The organizational support perceived by the participants did not have a statistically significant effect on their attitudes toward medical errors (β = 0.015; p = 0.865). The multiple linear regression model established in the study revealed that education level and previous medical error status were significant predictors of the attitudes of the participants toward medical errors.

Conclusion

It was determined that surgical nurses had positive attitudes toward the importance and reporting of medical errors and moderate perceived organizational support levels, and perceived organizational support did not significantly affect attitudes toward medical errors in surgical nurses.

Implications for nursing practice and health policy

In this study, it was determined that the perceived organizational support levels of surgical nurses did not have a significant effect on their attitudes toward medical errors. Assuming that adequate organizational support will reduce medical error rates, it is considered important to develop and implement policies to increase organizational support levels. Likewise, the use of safety reporting systems should be expanded to reduce medical error rates, reports should be used only to prevent and reduce risks, and systems and strategies should be developed instead of blaming individuals. In addition to the reporting of confirmed medical errors to ensure patient safety, the reporting of so‐called “near misses” is also very important. For this reason, institutional support should be provided regarding the importance of “near miss” events in error reporting. Necessary practices should be provided to identify, report, correct, and prevent these events.
Eclipse of the Public Corporation or Eclipse of the Public Markets?
Authors: Doidge Craig , Kahle Kathleen M. , Karolyi G. Andrew , Stulz René M.
Published: September 2023

The authors look back at Michael Jensen's 1989 article “The Eclipse of the Public Corporation.” They find some of his predictions have been borne out but other important ones, not. Jensen concluded that the publicly held corporation was in decline and had outlived its usefulness in many sectors. He argued that agency costs made public corporations an inefficient form of organization and that new private organizational forms promoted by private equity firms would likely replace the public firm.

The number of public firms in the U.S. has declined significantly but there are still many hugely profitable and successful public companies. U.S. public markets are still well‐suited for firms with mostly tangible assets. So, what we are really witnessing is an eclipse not of public corporations, but of the public markets as the place where young firms with mostly intangible capital seek their funding.

This is especially true when the usefulness of the intangible assets has yet to be proven. Sometimes the market is extremely optimistic about some intangible assets, but otherwise firms with unproven intangible assets may be better off funding themselves privately. This evolution has a downside: investors limited to public markets are cut off from investing in high intangible‐asset firms. Additionally, as fewer firms remain publicly listed, fewer firms will be transparent to society.
Fiduciary Duties of Corporate Directors in Uncertain Times
Authors: Millstein Ira M. , Odoner Ellen J. , Sharma Aabha
Published: September 2023

Confronting new political uncertainties, heightened challenges, and asserted “best practices,” directors may wonder whether their fiduciary duties have changed. The authors synthesize the latest decisions of the Delaware courts on the standards of conduct for directors and the standards by which their conduct is reviewed. While directors should expect uncertainty to be a fact of corporate life, neither the fiduciary duties of directors nor the protections afforded them have changed. Disinterested and independent directors, acting in good faith to make decisions they deem in the best interests of the corporation, continue to have broad protections under the business judgment rule. This legal framework enables and encourages active directors to make hard choices when they need to do so.

The paper includes flowcharts illustrating how the standards of judicial review apply to various categories of business decisions that directors may have to make. It concludes with practical suggestions for directors and General Counsels to establish business judgment rule protection for board decisions or, where applicable, withstand more stringent standards of review.
Global Trade – Hostage to the Volatile US Dollar
Authors: Kantor Brian
Published: September 2023

Brian Kantor says that every financial manager ought to have a multi‐decade historical perspective on foreign exchange rates to appreciate how quickly and dramatically rates can change. Managers should understand how domestic politics influences central bank policies and, ultimately, foreign exchange rates, even if unintentionally. Longer‐term historical perspectives are a necessary part of a solid decision‐making foundation.

He provides a summary foreign exchange history from the perspective of the South African Rand (ZAR) and the US dollar (USD). What is most remarkable about such exchange rates, perhaps, is not just the variation around established trends but the tendency of apparently well‐established trends to reverse completely. Kantor explains that, since 1970, the global economy has had to cope with flexible exchange rates that do not necessarily trend to Purchasing Power Parity “equilibrium.” This is a highly unsatisfactory feature of the global financial and trading system.

The chance of a reintroduction of genuinely fixed exchange rates seems very small, however. Business decision‐makers will have to cope as best they can with unpredictable real exchange rates.
Use of the informed health choices educational intervention to improve secondary students’ ability to think critically about health interventions in Uganda: A cluster‐randomized trial
Authors: Ssenyonga Ronald , Oxman Andrew D , Nakyejwe Esther , Chesire Faith , Mugisha Michael , Nsangi Allen , Semakula Daniel , Oxman Matt , Rose Christopher James , Rosenbaum Sarah E , Moberg Jenny , Kaseje Margaret , Nyirazinyoye Laetitia , Dahlgren Astrid , Lewin Simon , Sewankambo Nelson K
Published: September 2023

Aim:

The aim was to evaluate the effect of the Informed Health Choices (IHC) educational intervention on secondary students’ ability to assess health‐related claims and make informed choices.

Methods:

In a cluster‐randomized trial, we randomized 80 secondary schools (students aged 13–17 years) in Uganda to the intervention or control (usual curriculum). The intervention included a 2‐day teacher training workshop, 10 lessons accessed online by teachers and delivered in one school term. The lesson plans were developed for classrooms equipped with a blackboard or a blackboard and projector. The lessons addressed nine prioritized concepts. We used two multiple‐choice questions for each concept to evaluate the students’ ability to assess claims and make informed choices. The primary outcome was the proportion of students with a passing score (≥9 of 18 questions answered correctly).

Results:

Eighty schools consented and were randomly allocated. A total of 2477 students in the 40 intervention schools and 2376 students in the 40 control schools participated in this trial. In the intervention schools, 1364 (55%) of students that completed the test had a passing score compared with 586 (25%) of students in the control schools (adjusted difference 33%, 95% CI 26%–39%).

Conclusions:

The IHC secondary school intervention improved students’ ability to think critically and make informed choices. Well‐designed digital resources may improve access to educational material, even in schools without computers or other information and communication technology (ICT). This could facilitate scaling‐up use of the resources and help to address inequities associated with limited ICT access.
Using Systems Thinking and Complexity Theory to understand and improve Emergency Medicine: Lessons from COVID‐19 in a safety net health system
Authors: Rusoja Evan , Chad Swanson R. , Swift Mini
Published: September 2023

Rationale

COVID‐19 has fundamentally changed the practice of Emergency Medicine (EM). Care delivery on the front lines has historically depended upon ostensibly reliable input‐output models for staffing, supplies, policies, and therapies. Challenged by the complexity of healthcare during the pandemic, the fallibility of these reductionist models was quickly revealed. Providers and systems quickly had to reconceptualize their dependence on the wider, complex system in which healthcare operates and find adaptive solutions to rapid changes.

Aims/Method

This papers seeks to review and describe how Systems Thinking and Complexity Theory (ST/CT)—concepts, principles, and tools that can be used to understand and impact our constantly evolving health system—can be applied to better understand and enact change in complex settings such as during COVID‐19. Some of these ST/CT are described through the real world example of the Alameda Health System Vaccine Taskforce.

Results

ST/CT concepts such as Unintended Consequences, Interrelationships, Emergent Behavior, Feedback Loops, and Path Dependence can help EM providers and planners understand the context in which their system operates. Key principles such as Collaboration, Iterative Learning, and Transformational Leadership can help these actors respond to current and future challenges. The integration of these concepts and principles into the Learning Health System offers a model for tying these key concepts and principles together into an adaptive, cross‐sectoral organizational approach.

Conclusion

By integrating ST/CT into the practice of EM, we can not only improve our ability to care for patients but also our capacity to understand and strengthen our wider systems of care.
Evaluating shared decision making for dialysis initiation: A qualitative study on patient refusal of long‐term dialysis in Taiwan
Authors: Kuo Yi‐Ting , Jenq Chang‐Chyi , Li Uen Shuen , Lin Ya‐Ping
Published: September 2023

Rationale

Previous studies have explored shared decision making (SDM) implementation to determine the renal replacement therapy modality; however, the SDM approach for dialysis initiation, especially when patients refuse physician suggestions for long‐term dialysis, remains unclear.

Aims and Objectives

This study aimed to explore physicians' responses towards patients' refusal of long‐term dialysis during the SDM process and the thinking processes of both physicians and patients regarding dialysis refusal.

Method

We conducted in‐depth semi‐structured interviews with 10 patients diagnosed with end‐stage renal disease, each of whom refused long‐term dialysis after physicians employed the SDM framework, and nine nephrologists at the Chang Gung Memorial Hospital, Taiwan, from March to May 2020. Interviews were audio‐recorded, transcribed, and translated from Mandarin to English. They were then thematically analysed.

Results

Three main themes on dialysis initiation SDM implementation and the differences between physician and patient perceptions on patient treatment refusal were yielded. While the SDM approach for dialysis initiation developed by nephrologists in Taiwan respects patient decisions, physicians often actively persuade patients to undergo dialysis in case of treatment refusal. The motivation behind this approach is to promote the patient's best medical interests, particularly post‐dialysis life quality, and to ensure a ‘rational’ medical decision is made. However, patients' perceptions of treatment refusal differ significantly from those of physicians, and their decision‐making process is often iterative and based on comprehensive evaluation of immediate concerns beyond biomedical factors.

Conclusions

Findings suggest that the current physician‐led SDM approach for dialysis initiation characterises active persuasion with physicians' perspectives predominating the clinical encounter. To improve SDM implementation, we propose that physicians should acknowledge and understand patients' reasoning for dialysis refusal and the distinction between objective health and subjective well‐being during the decision‐making process.
The role of the lived body during the integration of the traumatic experience of the sternotomy scar: A case study
Authors: Tomán Edina , Pintér Judit Nóra , Hargitai Rita
Published: September 2023

Background

Open heart surgery is a potentially traumatic experience for patients, thus posing a real risk to both the patient's physical and mental health as well as bodily integrity. All of these can greatly affect the emotional relationship to the sternotomy scar, the physical aspect of self‐representation. Sternotomy scars mark patients for life, yet our knowledge of patients' subjective experiences is unknown.

Method

In our case study, we explore the embodied experiences of a woman (42) who underwent open heart surgery with the method of interpretative phenomenological analysis combined with drawings.

Results:

The body and the bodily experiences play a prominent role in the formation, healing process, and symbolism of a scar. The central core of the traumatic experience of open heart surgery is the attack against the patient's sensation of bodily integrity. The interviewee experiences the surgery as abuse committed on her body, a memory that is deeply etched both in the physical memory and in the form of a scar on the skin.

Conclusion:

Based on our study, it seems that the corporeal dimension of posttraumatic growth may develop after the traumatic experience of heart surgery, in which bodily intimacy with oneself and Significant Others plays a major role. In this case study, the objective reality of the heart as “sick” flesh and the “broken, pierced” bone (Körper), as well as the dissociation—and then its integration—of the lived, living body experience (Leib) are outlined. Our case study was analysed in the theoretical framework of phenomenology and psychoanalysis.
Intended and unintended consequences of strategies to meet performance benchmarks for rheumatologist referrals in a centralized intake system
Authors: Marshall Deborah A. , Tagimacruz Toni , Barber Claire E. H. , Cepoiu‐Martin Monica , Lopatina Elena , Robert Jill , Lupton Terri , Patel Jatin , Mosher Diane P.
Published: September 2023

Rationale

Timely assessment of a chronic condition is critical to prevent long‐term irreversible consequences. Patients with inflammatory arthritis (IA) symptoms require diagnosis by a rheumatologist and intervention initiation to minimize potential joint damage. With limited rheumatologist capacity, meeting urgency wait time benchmarks can be challenging. We investigate the impact of the maximum wait time guarantee (MWTG) policy and referral volume changes in a rheumatology central intake (CI) system on meeting this challenge.

Methods

We applied a system simulation approach to model a high‐volume CI rheumatology clinic. Model parameters were based on the referral and triage data from the CI and clinic appointment data. We compare the wait time performance of the current distribution policy MWTG and when referral volumes change.

Results

The MWTG policy ensures 100% of new patients see a rheumatologist within their urgency wait time benchmark. However, the average wait time for new patients increased by 51% (178–269 days). A 10% decrease in referrals resulted in a 76% decrease on average wait times (178–43 days) for new patients and an increase in the number of patients seen by a rheumatologist within 1 year of the initial visit.

Conclusion

An MWTG policy can result in intended and unintended consequences—ensuring that all patients meet the wait time benchmarks but increasing wait times overall. Relatively small changes in referral volume significantly impact wait times. These relationships can assist clinic managers and policymakers decide on the best approach to manage referrals for better system performance.
Isolation and identification of Chryseobacterium indologenes and its pathological changes in Pelodiscus sinensis
Authors: Xing Yangyang , Xue Mingyang , Xiao Zidong , Hu Xiaowei , Zhai Jiale , Zhang Chunjie , Jiang Nan , Fan Yuding , Meng Yan , Zhou Yong
Published: September 2023

The Chinese revered a species of aquatic reptile known as Pelodiscus sinensis as both an edible and medicinal species. When artificially breeding, many deaths occurred at the farmed P. sinensis, mainly due to excessive breeding density, water contamination, and turtles biting each other secondary to bacterial infections. In this study, an isolate of gram‐negative bacteria WH0623 was isolated from the liver and kidney of diseased P. sinensis to trace the potential pathogen of this disease. Based on biochemical characteristics and 16S rRNA gene sequencing analyses, this isolated strain of WH0623 was identified as Chryseobacterium indologenes. The strain's median lethal dose (LD50) was 3.3 × 105 colony‐forming units (CFU)/g per fish weight tested using artificial infection. Histopathological analysis revealed pathological changes, including cell swelling, hyperaemia, and necrosis in many tissues. Antibiotic susceptibility tests revealed that the bacteria WH0623 was susceptible to doxycycline, sulphonamides, ceftazidime, norfloxacin, and ciprofloxacin. These antibiotics could treat the disease. In conclusion, the pathogen causing the death of farmed P. sinensis was isolated and identified, and a drug‐sensitive test was conducted. Our findings contribute to the future diagnosis and treatment of the disease.
Frailty as a risk factor for post‐acute sequelae of COVID‐19 among US veterans during the Delta and Omicron waves
Authors: Hammel Iriana S. , Tosi Dominique M. , Tang Fei , Pott Henrique , Ruiz Jorge G.
Published: September 2023

Background

Older populations have suffered the highest rates of SARS‐CoV‐2 infection and associated complications, including Post‐Acute Sequelae of SARS‐CoV‐2 infection (PASC). Frailty is a geriatric syndrome that often coexists with COVID‐19 infection. The vulnerability to stressors caused by multisystemic dysfunction that characterizes frailty may predispose older adults to develop PASC.

Methods

Retrospective cohort study using the VA COVID‐19 Shared Data Resource to identify US veterans testing positive for SARS‐CoV‐2 between July 2021 and February 2022, without prior positive tests and who were alive 30 days after infection. Frailty was calculated using a 31‐item VA Frailty Index generated from electronic health records. We categorized Veterans into robust (FI ≤ 0.10), prefrail (FI: >0.10‐ < 0.21), and frail (FI ≥ 0.21). We assessed the association between frailty and PASC and vaccination and PASC using Cox survival model, adjusting for covariates.

Results

We identified 245,857 COVID‐19‐positive veterans surviving 30 days after infection. The mean age was 57.5 ± 16.5 years; 87.2% were males, 68.1% were white, and 9.0% were Hispanic. Almost half of the sample (48.9%) were classified as robust, while 28.3% were pre‐frail and 22.7% were frail; 99,886 (40.6%) were fully vaccinated, and 33,516 (13.6%) received booster doses. Over a median follow‐up of 143 days (IQR = 101), 23,890 (9.7%) patients developed PASC. Within 6 months after infection, frailty and pre‐frailty were associated with a 41% (adjusted HR [aHR]:1.40 (95% CI: 1.35–1.47) and 15% (aHR: 1.17 (95% CI: 1.11–1.19) increase in the risk of PASC compared with the robust, respectively. Vaccination and booster doses before infection were associated with a 27% (aHR: 0.73 (95% CI: 0.71–0.75) and 33% (aHR: 0.66 (95% CI: 0.63–0.69) reduction in the risk of developing PASC, respectively.

Conclusions

Frailty was associated with an increased risk of developing PASC. Vaccination was associated with a decreased risk of PASC, further reduced by booster doses. Early recognition of frailty in patients with COVID‐19 may assist in the early identification and management of PASC.
The affordability and obtainability of gluten‐free foods for adults with coeliac disease following their withdrawal on prescription in England: A qualitative study
Authors: Crocker Helen , Lewis Thomas , Violato Mara , Peters Michele
Published: September 2023

Background

Changes to prescribing policies in England have restricted or stopped access to gluten‐free food on prescription for people with coeliac disease in some geographical areas. The present study aimed to explore the impact of these changes on the affordability and obtainability of gluten‐free foods for adults with coeliac disease.

Methods

Semi‐structured qualitative interviews (n = 24) were conducted with people with coeliac disease living in areas where prescriptions for gluten‐free foods were no longer available, were restricted or followed national guidelines. Interviews explored the impact of gluten‐free prescribing changes on the affordability and obtainability of gluten‐free food, as well as dietary adherence.

Results

All participants considered gluten‐free substitute foods to be expensive. Participants felt the availability of gluten‐free foods has improved over time, also acknowledging some challenges remain, such as limited local availability. For most, the withdrawal of prescriptions had minimal impact requiring small adjustments such as reducing the quantity of foods obtained. However, greater challenges were faced by those less mobile, permanently sick or disabled and/or on lower incomes.

Conclusions

The majority of participants affected by the withdrawal of prescriptions were able to adapt to cope with these changes. However, participants with mobility issues, who are permanently sick or disabled and/or on lower incomes were struggling to afford and obtain gluten‐free substitute foods from elsewhere. The withdrawal of prescriptions may further widen health inequalities. Further research should focus on the long‐term impacts of prescription withdrawal for the vulnerable groups identified.
Antenatal healthcare providers' knowledge, attitudes and practices regarding food insecurity in pregnancy: A qualitative investigation based at a specialist antenatal hospital in Melbourne, Australia
Authors: Dickson Amanda , McKay Fiona , Zinga Julia , van der Pligt Paige
Published: September 2023

Background

Food insecurity exists when accessibility and availability of nutritious food is restricted, increasing the risk of adverse health outcomes. Pregnant women are especially vulnerable to food insecurity, which is concerning as optimal nutrition to support both their own health and the health and growth of their unborn child is critical. Antenatal healthcare providers (AHPs) are central to provision of pregnancy care. We aimed to assess AHPs' knowledge, attitudes and management of food insecurity.

Methods

Semi‐structured interviews were conducted face‐to‐face, via telephone or online via Webex with 16 AHPs at the Royal Women's Hospital located in Melbourne, Australia. Interviews were thematically analysed according to Charmaz's constructivist grounded theory approach to ascertain AHPs' knowledge, attitudes and practices regarding food insecurity during pregnancy.

Results

AHPs had limited knowledge and awareness of food insecurity in pregnancy. Lack of experience in managing food insecurity and time constraints limit their capacity to support and deliver care to food‐insecure women. There was a reported lack of structure and clarity surrounding referral pathways for effective management of food insecurity during pregnancy, as well as a lack of clarity regarding practitioner responsibility in managing this issue.

Conclusions

Current assessment and management of food insecurity during pregnancy in the antenatal setting is suboptimal. Professional development strategies targeted to AHPs are urgently needed to assist optimal care of women who are food insecure during pregnancy to assist with supporting best maternal and child health.
A standardised nutritional drink as a test meal for the 13C mixed triglyceride breath test for pancreatic exocrine insufficiency: A randomised, two‐arm crossover comparative study
Authors: Powell‐Brett Sarah , Hall Lewis A. , Roberts Keith J.
Published: September 2023

Background

The 13C mixed triglyceride breath test (13C MTGT) is a diagnostic test for pancreatic exocrine insufficiency (PEI). It is poorly standardised with much heterogeneity of the test meal, the commonest being toast and butter. A standardised oral nutritional supplement that could be easily transported, stored and made up would be valuable for making this test accessible outside of specialist centres.

Methods

A prospective, randomised, two‐arm crossover study of different test meals was carried out in 14 healthy controls. The 13C MTGT was performed in identical conditions on two separate days. Two test meals were given in random order, either standard (toast and butter) or novel (oral nutritional supplement), with 250 mg of 13C‐labelled mixed triglyceride incorporated. Breath samples were taken postprandially to calculate cumulative percentage dose recovery (cPDR) of 13C at 6 h.

Results

All 14 participants completed both arms of the study with no protocol deviations. The mean cPDR was 39.39% (standard deviation [SD] 5.19) for the standard test meal and 39.93% (SD 5.20) for the novel test meal. A one‐way repeated measures analysis of variance (ANOVA) found no significant difference in cPDR between the two meals, F(1, 13) = 0.18, p = 0.68 (minimum detectable difference of 0.81 at 80% power).

Conclusion

This study demonstrates that a standardised oral nutritional supplement can be used without compromising 13C recovery. Using this test meal provides a standardised dietary stimulus to the pancreas, avoiding possible variation in quantity of dietary components with other test meals. Further, the ease of use of this method would help establish the 13C MTGT test more widely.
Two pregnant women with immune‐mediated thrombotic thrombocytopenic purpura: A case report
Authors: Uchida Akiko , Tanimura Kenji , Sasagawa Yuki , Yamada Hirotaka , Katayama Yoshio , Matsumoto Masanori
Published: September 2023

Thrombotic thrombocytopenic purpura (TTP) during pregnancy is life‐threatening. We encountered two pregnant women with immune‐mediated TTP (iTTP). A 40‐year‐old primigravida woman was referred at 19 gestational weeks (GWs) owing to iTTP. She received plasma exchange (PE) and steroid therapies and delivered a live infant at 27 GWs by cesarean delivery. A 29‐year‐old primigravida woman was referred owing to intrauterine fetal death and thrombocytopenia at 20 GWs. She was diagnosed with iTTP and received PE therapy. She required additional PE and steroid therapies owing to relapse. Before her second pregnancy, she received prednisolone and hydroxychloroquine according to the therapy for systemic lupus erythematosus (SLE). She had induced labor at 37 GWs owing to decrease plasma level of a disintegrin‐like and metalloproteinase with thrombospondin type 1 motif 13 (ADAMTS13) activity. Close monitoring of plasma ADAMTS13 activity level and treatments for underlying SLE may prevent iTTP relapse and lead to a good prognosis.
Multiple change point detection under serial dependence: Wild contrast maximisation and gappy Schwarz algorithm
Authors: Cho Haeran , Fryzlewicz Piotr
Published: September 2023

We propose a methodology for detecting multiple change points in the mean of an otherwise stationary, autocorrelated, linear time series. It combines solution path generation based on the wild contrast maximisation principle, and an information criterion‐based model selection strategy termed gappy Schwarz algorithm. The former is well‐suited to separating shifts in the mean from fluctuations due to serial correlations, while the latter simultaneously estimates the dependence structure and the number of change points without performing the difficult task of estimating the level of the noise as quantified e.g. by the long‐run variance. We provide modular investigation into their theoretical properties and show that the combined methodology, named WCM.gSa, achieves consistency in estimating both the total number and the locations of the change points. The good performance of WCM.gSa is demonstrated via extensive simulation studies, and we further illustrate its usefulness by applying the methodology to London air quality data.
Rheology of liquid foods under shear flow conditions: Recently used models
Authors: Martínez‐Padilla Laura Patricia
Published: September 2023

Proper modeling of flow or viscosity curves as a function of shear rate is a useful tool in any engineering activity. The rheology of foods depends on the composition, processing to which they have been subjected and the state of dispersion in which they are found. Liquid foods are complex biosystems, that show non‐Newtonian behavior under flow conditions. This review presents models used in recent decades to describe the experimental rheological behavior of various liquid foods, ranging from Newtonian fluids to the most complex. Some non‐Newtonian parameters such as those of the Ostwald‐de Waele, Bingham, Herschel–Bulkley, Casson, Cross, and Carreau models are summarized. Examples of thixotropic behavior described by the Weltman and Abu‐Jdayil models are also presented. In each model, explanations based on the composition and dispersion state of the food are made. This is useful in innovative processing technologies and for scientists new to the field of food rheology. An attempt is made to exemplify and group the expected behavior for most fluid foods, including some for a dysphagia diet, depending on their composition or the dispersed system formed, which will be useful for professionals who wish to compare reported rheological parameters with those obtained experimentally.
Seventy‐five years West German currency reform: Crisis as catalyst for the erosion of the market order
Authors: Schnabl Gunther
Published: September 2023

The paper analyzes the role of the 1948 currency and economic reform in West Germany for growth and social cohesion in Germany and Europe. It describes the theoretical foundation by Walter Eucken and the implementation and defense of the new economic order by Ludwig Erhard. The paper stresses the positive impact of the market economy on growth and welfare in Germany and Europe. Then, it is shown that Eucken's constituting principles of the market economy were gradually eroded after euro introduction in course of crises, with the negative repercussions on growth and equality being explained. The policy conclusion is that only the reconstitution of price stability in the euro area can prevent a further decline of welfare in Europe. The 1948 economic reforms provide an important blueprint for the necessary reform process.
Ascidian diversity and abundance in North Carolina seagrass meadows
Authors: Surprenant Mina , Jarvis Jessie C. , López‐Legentil Susanna
Published: September 2023

Ascidians are sessile marine invertebrates found all over the world in a variety of natural and artificial habitats. The objective of this study was to provide the first inventory of ascidian diversity and abundance in North Carolina (NC) seagrass meadows. Eight sites along the NC coast were surveyed in May and June 2021 and at each site, 20 quadrats were deployed. All ascidian species within the quadrats were counted and identified based on morphological characterization and sequencing of the barcoding gene. Seagrass percent cover, biomass, and shoot density were also quantified. Ascidians were found in six sites and four species were recorded: the solitary species Molgula manhattensis, Styela plicata, and Bostrichobranchus sp., and the colonial Didemnum lutarium. Colonial specimens were generally attached to hard substrate, while solitary species were often found attached to seagrass rhizomes and leaves. S. plicata and M. manhattensis haplotype diversity were equivalent to previous descriptions from individuals collected on artificial substrates and other locations. Ascidian abundance was positively correlated with seagrass biomass but not with seagrass percent cover. A fifth species, the solitary Styela canopus, appeared in a site revisited in October 2021. Temperate ascidians are known to have seasonal cycles, thus further research should include monthly surveys to assess ascidian diversity and abundance over time.
Life‐stage specificity and cross‐generational climate effects on the microbiome of a tropical sea urchin (Echinodermata: Echinoidea)
Authors: Marangon Emma , Uthicke Sven , Patel Frances , Marzinelli Ezequiel M. , Bourne David G. , Webster Nicole S. , Laffy Patrick W.
Published: September 2023

Microbes play a critical role in the development and health of marine invertebrates, though microbial dynamics across life stages and host generations remain poorly understood in most reef species, especially in the context of climate change. Here, we use a 4‐year multigenerational experiment to explore microbe–host interactions under the Intergovernmental Panel on Climate Change (IPCC)‐forecast climate scenarios in the rock‐boring tropical urchin Echinometra sp. A. Adult urchins (F0) were exposed for 18 months to increased temperature and pCO2 levels predicted for years 2050 and 2100 under RCP 8.5, a period which encompassed spawning. After rearing F1 offspring for a further 2 years, spawning was induced, and F2 larvae were raised under current day and 2100 conditions. Cross‐generational climate effects were also explored in the microbiome of F1 offspring through a transplant experiment. Using 16S rRNA gene sequence analysis, we determined that each life stage and generation was associated with a distinct microbiome, with higher microbial diversity observed in juveniles compared to larval stages. Although life‐stage specificity was conserved under climate conditions projected for 2050 and 2100, we observed changes in the urchin microbial community structure within life stages. Furthermore, we detected a climate‐mediated parental effect when juveniles were transplanted among climate treatments, with the parental climate treatment influencing the offspring microbiome. Our findings reveal a potential for cross‐generational impacts of climate change on the microbiome of a tropical invertebrate species.
Underdeterminacy without ostension: A blind spot in the prevailing models of communication
Authors: Bonard Constant
Published: September 2023

Together, the code and inferential models of communication are often thought to range over all cases of communication. However, their prevailing versions seem unable to fully explain what I call underdeterminacy without ostension. The latter is constituted by communication where stimuli that are not (nor appear to be) produced with communicative or informative intentions nevertheless communicate information underdetermined by the relevant codes. Though the prevailing accounts of communication cannot fully explain how communication works in such cases, I suggest that some version of the inferential model can—if we allow it to extend to non‐ostensive, non‐intentional behaviors.
Linguistic Interval as Spiritual Interplay: Przywara's “Dynamic Polarity” and Christian Language
Authors: Bickersteth Samuel
Published: September 2023

This article aims to reflect on how Erich Przywara's concept of the analogical “dynamic polarity” can contribute to contemporary discussions regarding the role of language in postmodern theology. By opposing Przywara to the philosophies of the likes of John Caputo and Jacques Derrida—in particular their concept of the khôra, and the former's “weak theology” —it intends to elucidate the possibility of an approach to language which remains in keeping with the Christian theological (and thus metaphysical) tradition whilst also engaging with standard postmodern criticisms typically leveled at it. Beginning with a prefatory examination of the themes of presence, absence, and distance as they appear in Christian theology and postmodernism, it then examines how the dynamic polarity may play a conciliatory role in harmonizing the two. It then continues to employ the dynamic polarity as a basis for various forms of language, arguing that it reveals an inherently relational, dialogic, and ultimately prayerful structure of receptivity, one which constitutes and emboldens difference, enlivening it as the theatre for a fruitful analogical interplay between self and other, cataphatic and apophatic, and more.
Syphilis as the great mimicker: A case of full‐house pattern membranous nephropathy
Authors: Fan Shu Ling , Landgren Anthony , Ruderman Irene
Published: September 2023

Syphilis is a known cause of membranous nephropathy. We describe a case of a patient presenting with nephrotic syndrome whose renal biopsy demonstrated a ‘full house’ immunohistochemical pattern with positive IgG, IgM, C1q, IgA, C3c, and C4d staining. He was treated with immunosuppressive agents for minimal change nephropathy and subsequently class V lupus nephritis, before syphilis infection was confirmed. Following treatment with a single dose of intramuscular benzathine penicillin there was complete and rapid resolution of nephrotic syndrome. With progressive rising incidence in the western world, syphilis is an important and under‐recognised differential diagnosis in cases of nephrotic syndrome.
Hypertension in oral lichen planus: A systematic review and meta‐analysis
Authors: De Porras‐Carrique Teresa , Ramos‐García Pablo , González‐Moles Miguel Ángel
Published: September 2023

Objectives

To perform a systematic review and meta‐analysis in order to qualitatively and quantitatively evaluate the prevalence and magnitude of the association of hypertension in patients with oral lichen planus (OLP).

Methods

MEDLINE, Embase, Scopus, and Web of Science databases were searched for studies published before May 2022, not restricted by publication language or date. The methodological quality and risk of bias of primary‐level studies were critically assessed. Meta‐analyses were performed, as well as meta‐regression, stratified, sensitivity and small‐study effects analyses, a Galbraith (radial) plot, and trial sequential analysis. Quality of evidence was evaluated using GRADE system.

Results

104 studies, including 16,587 patients, met the inclusion criteria. The results show that patients who suffer from OLP have a high prevalence of hypertension (PP = 24.17%, 95% CI = 21.45–27.00), with a low quality of evidence. A significant association between hypertension and oral lichen planus was also reported (OR = 1.28, 95% CI = 1.01–1.63, p = 0.04), showing a moderate quality of evidence.

Conclusions

Patients with OLP could be at an increased risk of suffering from hypertension which is probably due to multiple factors. Healthcare practitioners involved in OLP management should be aware of this comorbidity in order to apply suitable measures and make referrals if hypertension is suspected, although further research is needed.
Lactobacillus fermentum attenuates the alveolar bone loss in ligature‐induced periodontitis in mice
Authors: Lee Yuni , Jung Bo Hyun , Yoo Ki‐Yeon , Lim Hye Ji , Shin Kum‐Joo , Lee Jae‐Kwan
Published: September 2023

Objective

This study investigated the effects of Lactobacillus fermentum BELF11 on periodontitis in mice (LIP).

Methods

Sixty mice were randomly assigned to a control group (CTL), LIP/PBS group (LIP and PBS applied), or LIP/BELF11 group (LIP and L. fermentum BELF11 applied). For 14 days, PBS or L. fermentum BELF11 was applied twice daily to the mice in the LIP/PBS or LIP/BELF11 group, respectively. After 14 days, radiographic, histological, and pro‐inflammatory cytokine assessments were conducted.

Results

The LIP/PBS and LIP/BELF11 groups demonstrated greater alveolar bone loss than the CTL group (p < 0.05). The LIP/BELF11 group showed significantly reduced alveolar bone loss on the mesial side compared to the LIP/PBS group. Histologically, the LIP/BELF11 group showed consistent patterns of connective tissue fiber arrangement, lower levels of inflammatory infiltration, less alveolar bone loss, and higher alveolar bone density than the LIP/PBS group, despite showing more signs of destruction than the CTL group. The LIP/BELF11 group also exhibited significantly lower levels of pro‐inflammatory cytokines than the LIP/PBS group.

Conclusions

L. fermentum BELF11 inhibits alveolar bone loss and periodontitis progression by regulating pro‐inflammatory cytokine production. These findings suggest that L. fermentum BELF11 may be a potential adjunctive therapy in periodontal treatment.
Computer‐aided Design and 3D‐printed Personalized Stem‐plate Composite for Precision Revision of the Proximal Humerus Endoprosthetic Replacement: A Technique Note
Authors: Li Zhuangzhuang , Lu Minxun , Zhang Yuqi , Gong Taojun , Wang Jie , Luo Yi , Zhou Yong , Min Li , Tu Chongqi
Published: September 2023

Background

Aseptic loosening is considered to be a rather uncommon complication in proximal humerus endoprosthetic replacement (PHER). However, patients with aseptic loosening often suffer severe bone loss, which poses a great challenge in following revision. Under this situation, a standard stemmed endoprosthesis is unavailable for revision limb salvage. Computer‐aided design and 3D‐printed personalized implants are an emerging solution for reconstructing complex bone defects.

Case Presentation

Here, we present a 67‐year‐old male who underwent PHER after tumor resection and developed aseptic loosening with severe periprosthetic osteolysis around the stem. Computer‐aided design and 3D‐printed personalized stem‐plate composite was used for the precision revision of this patient. During the follow‐up, encouraging results were observed, with good endoprosthetic stability and satisfactory limb function.

Conclusion

Computer‐aid design and 3D‐printed personalized stem‐plate composite used in the present case could help to achieve good endoprosthetic stability and satisfactory limb function. This 3D‐printed personalized stem‐plate composite seems to be an effective method for the precise revision of PHER in patients with severe periprosthetic osteolysis. In addition, it also provides a novel method for similar revision surgery of other joints or primary endoprosthetic replacement with severe bone defects.
Effectiveness of integrated approach of yoga therapy versus usual care in management on chronic low back pain patients: A randomized controlled pilot study
Authors: Poojari Spoorthi , Dhiman Deepanshu , Ghai Babita , Mathur Deepali , Metri Kashinath , Kataria Ketan , Anand Akshay
Published: September 2023

Background

Chronic low back pain is associated with both psychological and functional limitation. Yoga therapy has been shown to improve both the aspects. The present study was planned to evaluate integrated approach of yoga therapy with usaul care.

Aims

This controlled randomized trial was done to evaluate the clinical and molecular changes resulting from integrated approach of yoga therapy (IAYT) as an adjunct regimen and compared it with usual care for the management of chronic low back pain patients.

Material and methods

We enrolled 29 adult patients with non‐specific chronic low back pain (CLBP). Patients were randomly divided into two groups. The control group received the usual care of treatment as per institutional protocol. The yoga group received IAYT as an adjunct to usual care. Primary outcomes were pain intensity assessed by verbal numerical rating scale (VNRS) and functional ability assessed by Modified Oswestry Disability Index (MODI). Secondary outcomes were pain catastrophizing, quality of life, fear of movement related to CLBP, type of pain, levels of β‐endorphin and TNF‐α, and salivary CGRP. All parameters were measured at baseline, 1 and 3 months.

Results

A Significant decrease in VNRS score at 1 and 3 months was observed in both the groups with the yoga group showing a more significant reduction in pain over time than the control group (p = 0.036). MODI improved significantly only in the yoga group at 1 and 3 months. Intergroup comparison revealed significantly better MODI over time in the yoga group (p < 0.001). DN4, PDQ, PCS, HADS (anxiety), and Euro QOL had a statistically significant improvement at 1 and 3 months in the yoga group compared with the control group. The HADS (depression) had a statistically significant reduction scores in the yoga group at 3 months compared with the control group (p = 0.012). There was a significant reduction in TNF‐α values in the yoga group compared with baseline (p = 0.004).

Conclusion

IAYT therapy helped in addressing the psychological components of pain and improved quality of life patients with chronic low back pain compared with usual care.