bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrating place-based and virtual models of palliative care: A case report
Authors: Toll Kaylie , Villis Amanda , Moullin Joanna
Published: January 2024

Palliative care management in rural and remote areas generally relies on local resources including a primary healthcare professional and a local health facility. Either in the absence of a primary healthcare professional, or in more complex cases, a patient is frequently transferred to a larger rural- or metropolitan-based health facility, away from community and local supports. With increasing challenges in locum availability, healthcare professionals are challenged in looking out for their own wellness needs, often having to choose between taking time-off or staying on duty and available to provide ongoing care for their patients. In this case report, we describe an alternative hybrid model of care which integrates place-based and virtual management, utilising digital health technologies. This approach supported a rural healthcare professional to take leave, by transferring the care and management of a palliative care patient to the WA Country Health Inpatient Telehealth Service, allowing the patient to remain in their local community and die in their place of choice. Access to palliative care is of great importance to quality care and its impacts cannot be overstated for the person with a terminal illness and their family, it is also important to take into consideration the role of the health professional and their well-being.
The Equality Act 2010 - changes in 2024 including Brexit-related codification
Authors: Hand James
Published: January 2024

This legislative note considers the widespread changes to the Equality Act 2010 which have been made or are set to be made in 2024. These are predominantly but not exclusively as a result of Brexit and the effect of the Retained EU Law (Revocation and Reform) Act 2023 and see indirect effect give way to express statutory provisions. The breadth of the changes span: aspects of the definitions of direct discrimination, indirect discrimination, pregnancy and maternity discrimination and the protected characteristic of disability; the unlawful acts of discrimination (regarding discriminatory public statements) and harassment (introducing positive duty on employers to prevent sexual harassment of employees); changes to the equal pay provisions.
Decolonizing bodies and the ethics of care: On the significance of embodied vulnerability as the future of cultural studies
Authors: Durham Meenakshi Gigi
Published: January 2024

In the contemporary moment, systemic failures – from climate change to pandemics to political repression – have created embodied vulnerabilities worldwide. I argue here that the increasing precaritization of individual bodies is an index of the political formations that create and condition vulnerabilities among certain populations. Recognizing this, analyses of the conditions of embodied vulnerability are crucial to cultural studies in that they contribute to understanding and challenging neocolonial and patriarchal power and injustice. Feminist materialism and theories of post- and neo-colonialism reveal the processes of embodiment as complex modes of epistemic violence. To reorient cultural studies theoretically and methodologically, I propose the feminist ethics of care as a working framework for mapping, challenging, and changing the processes of materialization at work in unjust and asymmetric embodied vulnerabilities.
Study on weak sound signal separation and pattern recognition under strong background noise in marine engineering
Authors: Liu Song , Gao Jiantong , Zhou Huayu , Yang Kang , Liu Panpan , Du Yifan
Published: January 2024

The extraction of weak acoustic signals under strong background noise is of great significance in the applications of target identification and localization. In this paper, the pulse signal with high randomness is set as the weak signal sound source, random noise and sine sound are used as the background noise. Under the condition of a signal-to-noise ratio of −20 dB, combined with blind source separation and neural network methods, the collected observation signals are subjected to weak sound signal separation and recognition research. The optimization method of centralization and scaling processing is used to eliminate the unfavorable influence of the uncertainty of the separated signal amplitude caused by the blind source separation method on the pattern recognition. The recognition result is verified by the combination of “weak impulse acoustic signal” and “random noise signal,” and the output vector (0.99 0.01 0.01) approaches (1 0 0), which is recognized as impulse acoustic signal. By combining blind source separation and neural network methods, the separation and identification of weak pulse signals under the condition of a signal-to-noise ratio of −20 dB can be achieved.
Religion, Perceived Unfairness, and Political Protest: Empirical Evidence From East Asian Countries
Authors: Chang Wen-Chun
Published: January 2024

Religion is considered to have different aspects of influences on political protest, and some have argued that religious participation often mobilizes collective political actions by enhancing individuals’ civic skills and political efficacy. By contrast, religious values and beliefs that emphasize the importance of traditional norms and conformity tend to reduce individuals’ propensities to participate in political protest. The influences of religion on individuals’ attitudes toward coping with injustice and unfairness can be critical for explaining their propensities to participate in political protest. Using data from the fourth wave of the Asian Barometer Survey, this study investigates the role of perceived unfairness in shaping the link between religion and political protest in 13 East Asian countries. In accordance with the arguments of mobilizing and conforming effects, we find that religious attendance increases individuals’ propensities to engage in political protest, while religiosity has a negative effect on political protest. In particular, the results show that the perceived unfairness of income distribution mediates the indirect effects of religion on political protest. They also present that religious affiliations mitigate perceived unfairness and indirectly reduce individuals’ propensities to participate in political protest. Nevertheless, the direct effects of religious attendance on mobilizing political protest are stronger.
Potential Efficacy of Shiunko for Anti-Epidermal Growth Factor Receptor (EGFR) Monoclonal Antibody-Induced Skin Fissure: A Single Institutional Case Series
Authors: Okunaka Mashiro , Kotani Daisuke , Mishima Saori , Nakamura Maho , Kawazoe Akihito , Bando Hideaki , Yoshino Takayuki , Shitara Kohei
Published: January 2024

Purpose:

Anti-epidermal growth factor receptor monoclonal antibody (anti-EGFR mAb) is the key drug for RAS/ BRAF V600E wild-type metastatic colorectal cancer (mCRC). However, anti-EGFR mAb-induced skin fissures often affect a patient’s quality of life. Shiunko, a traditional Japanese topical herbal medicine, is used for burns and dermatitis and may potentially have wound-healing effects. Herein, we report cases of patients with mCRC who were treated with Shiunko for anti-EGFR mAb-induced skin fissure.

Methods:

We retrospectively reviewed consecutive patients with mCRC who received an anti-EGFR mAb-containing regimen and were treated with Shiunko twice a day for skin fissures at the National Cancer Center Hospital East between March 2022 and December 2022. Skin fissures were assessed at baseline and at every visit until 28 days after Shiunko initiation according to CTCAE v5.0.

Results:

Among the 11 patients, 5 patients were female; the median age was 61 (range, 43-79) years. The median treatment duration with anti-EGFR mAb before Shiunko initiation was 13.1 (range, 6-52) weeks. Skin moisturizer and topical steroids were applied for skin fissures in 11 and 5 patients, respectively. All patients had grade 2 skin fissures at baseline of Shiunko initiation. Two weeks after Shiunko initiation, complete recovery was noted in 4 patients and improvement to grade 1 was noted in 6 patients. There were no Shiunko-related adverse events. Ten patients continued anti-EGFR mAb treatment until disease progression, while 1 patient discontinued anti-EGFR mAb treatment due to severe eruptions.

Conclusion:

Shiunko could be a treatment option for anti-EGFR mAb-induced skin fissure. Further studies are warranted to investigate the efficacy and safety of Shiunko for anti-EGFR mAb-induced skin fissure.
Defining the Parameters for Endovenous Microwave Ablation to Achieve Equivalence With Endovenous Laser Ablation, Using the Porcine Liver Model
Authors: Bachetta Anjali , Cheung Simon , Moore Emma R. , Nguyen Danny , Kiely Melissa J. , Whiteley Mark S.
Published: January 2024

Aims

Endovenous microwave ablation (EMWA) is an endovenous thermoablation (EVTA) system to ablate incompetent truncal veins. Early results suggest that EMWA uses more power than endovenous laser ablation (EVLA) to get the same results. We aimed to define the parameters for EMWA, which give the same tissue ablation as EVLA, using the validated porcine liver model.

Methods

EVLA (1470 nm 600 micron radial fibre) treatments were performed at 6 W, 8 W and 10 W, at pullback speeds of 6, 7, 8 and 9 s/cm, giving Linear Endovenous Energy Densities (LEEDs) between 36 - 90 J/cm. Each combination of power and pullback was repeated 5 times. We then used EMWA in the same model. Powers of 35-75 W and pullback speeds of 4-9 s/cm were used (LEEDs 140-675 J/cm). Ablation tracts from both devices were analysed by 2 blinded observers, noting thermal spread and carbonisation.

Results

For each commonly used parameter for EVLA, we identified a range of parameters for EMWA that produced similar tissue ablation in the porcine liver model. To keep the pullback speeds within the usual range, powers of 35-75 W were needed with EMWA, with mean EMWA LEEDs 3.9 - 5.8 times higher than EVLA LEEDs. We found the quicker the pullback speed, the higher the multiple of EMWA LEED we needed to get the same effect.

Conclusion

We have identified parameters for EMWA that gave equivalent tissue ablation in the porcine liver model to commonly used parameters used for EVLA. These need to be validated clinically, but as the model used has already been validated against clinical outcome in endovenous thermal ablation, there is little reason to suspect that these results would not be valid. As the power during EMWA is higher than EVLA, EVMA LEEDs are approximately 4-6 times higher than EVLA LEEDs to achieve the same thermal effect on the tissues.
A Novel Microsnare and Microwire Coil Retrieval Technique
Authors: Beal Taylor , Say Conrad , Ghasemi Rad Mohammad , Leon David
Published: January 2024

Coil migration during endovascular embolization is a complication that can result in thromboembolic occlusion leading to potentially large infarcts if not removed. Microsnares are commonly used to remove migrated coils. Current techniques, however, struggle in cases where the microsnare is unable to loop over and secure a free end of the coil. We present a case in which a microsnare combined with a microwire successfully removed a migrated coil in a patient with a bleeding hepatic pseudoaneurysm post-embolization. This technique proved beneficial when traditional methods were insufficient, especially in small vessels or coil packs that cannot be snared. The synergy of the microsnare and microwire technique presents a promising solution for challenging migrated coil retrievals.
Understanding the Pathophysiology of Mental Diseases and Early Diagnosis Thanks to Electrophysiological Tools: Some Insights and Empirical Facts
Authors: Sumiyoshi Tomiki , Campanella Salvatore , Giordano Giulia Maria , Ishii Ryouhei , Pogarell Oliver
Published: January 2024

Objective. Neurophysiological tools remain indispensable instruments in the assessment of psychiatric disorders. These techniques are widely available, inexpensive and well tolerated, providing access to the assessment of brain functional alterations. In the clinical psychiatric context, electrophysiological techniques are required to provide important information on brain function. While there is an immediate benefit in the clinical application of these techniques in the daily routine (emergency assessments, exclusion of organic brain alterations), these tools are also useful in monitoring the progress of psychiatric disorders or the effects of therapy. There is increasing evidence and convincing literature to confirm that electroencephalography and related techniques can contribute to the diagnostic workup, to the identification of subgroups of disease categories, to the assessment of long-term causes and to facilitate response predictions. Methods and Results. In this report we focus on 3 different novel developments of the use of neurophysiological techniques in 3 highly prevalent psychiatric disorders: (1) the value of EEG recordings and machine learning analyses (deep learning) in order to improve the diagnosis of dementia subtypes; (2) the use of mismatch negativity in the early diagnosis of schizophrenia; and (3) the monitoring of addiction and the prevention of relapse using cognitive event-related potentials. Empirical evidence was presented. Conclusion. Such information emphasized the important role of neurophysiological tools in the identification of useful biological markers leading to a more efficient care management. The potential of the implementation of machine learning approaches together with the conduction of large cross-sectional and longitudinal studies was also discussed.
Lifestyle Factors and Heart Health: Exploring Effect Modification Using Behavioral Risk Factor Surveillance System Survey Data
Authors: Leal Raeann , Spencer-Hwang Rhonda , Beeson W Lawrence , Paalani Michael , Dos Santos Hildemar
Published: January 2024

This study examined the potential relationship between sleep, exercise, and depression with coronary heart disease (CHD) using the 2020 Behavioral Risk Factor Surveillance System (BRFSS) (n = 391 750) during the COVID-19 pandemic. CHD was defined as the presence of self-reported CHD or myocardial infarction (MI). Descriptive statistics were used to report variable frequencies and percentages. Logistic regression models were used to assess potential relationships between lifestyle behaviors (individually and for effect modification) and CHD, with additional sensitivity analysis comparing depressed subjects with non-depressed subjects. Sleep and exercise were assessed in the model for potential effect modification. Those with insufficient sleep and those who did not exercise were more likely to report CHD ( sleep OR = 1.09; 95% CI: 1.06, 1.12); ( exercise OR = 2.00; 95% CI: 1.95, 2.05), though the interaction term was non-significant. Those with self-reported depression were found to be associated with CHD (OR = 1.34; 95% CI: 1.30, 1.38). Among depressed individuals, insufficient sleep and no exercise exhibited a stronger association ( sleep OR = 1.19; 95% CI: 1.13,1.25); ( exercise OR = 2.13; 95% CI = 2.03, 2.23). Results support an association between sleep, exercise, and self-report of CHD, and this association is potentially magnified among depressed individuals, which may be further exacerbated by the COVID-19 pandemic.
A Bayesian adaptive design approach for stepped-wedge cluster randomized trials
Authors: Wang Jijia , Cao Jing , Ahn Chul , Zhang Song
Published: January 2024

Background:

The Bayesian group sequential design has been applied widely in clinical studies, especially in Phase II and III studies. It allows early termination based on accumulating interim data. However, to date, there lacks development in its application to stepped-wedge cluster randomized trials, which are gaining popularity in pragmatic trials conducted by clinical and health care delivery researchers.

Methods:

We propose a Bayesian adaptive design approach for stepped-wedge cluster randomized trials, which makes adaptive decisions based on the predictive probability of declaring the intervention effective at the end of study given interim data. The Bayesian models and the algorithms for posterior inference and trial conduct are presented.

Results:

We present how to determine design parameters through extensive simulations to achieve desired operational characteristics. We further evaluate how various design factors, such as the number of steps, cluster size, random variability in cluster size, and correlation structures, impact trial properties, including power, type I error, and the probability of early stopping. An application example is presented.

Conclusion:

This study presents the incorporation of Bayesian adaptive strategies into stepped-wedge cluster randomized trials design. The proposed approach provides the flexibility to stop the trial early if substantial evidence of efficacy or futility is observed, improving the flexibility and efficiency of stepped-wedge cluster randomized trials.
Understanding the contribution of intellectual disabilities nurses. Paper 4 of 4 - Impacts of intellectual disability nursing interventions
Authors: Mafuba Kay , Chapman Hazel M , Chester Rebecca , Kiernan Joann , Kudita Chiedza , Kupara Dorothy
Published: January 2024

Internationally, there is a wide variety of roles and expectations for intellectual disabilities nurses, and the range of nursing interventions they undertake in this field has not been clearly identified. In this paper we report the impacts of intellectual nursing interventions from an online survey of intellectual disability nurses. An online survey, using voluntary response sampling was used to collect case study examples from 230 participants from seven countries. We identified 13 themes of the impacts, and 23 broad groups of case examples of intellectual disability nursing interventions with, pregnant women, children, adults, older adults, and people at the end of life. Awareness of the roles of intellectual disability nurses and their importance in addressing health inequalities and facilitating the use of mainstream services for people with intellectual disabilities will enable improved healthcare experience and healthcare outcomes for people with intellectual disabilities.
Improving access, understanding, and dignity during miscarriage recovery in British Columbia, Canada: A patient-oriented research study
Authors: Van Tuyl Rana
Published: January 2024

Background:

Approximately 15%–25% of clinical pregnancies end in miscarriage, with more than 15,000 miscarriages occurring annually in British Columbia, Canada. Despite the significant rates of loss, research and health care services for pregnancy loss remain scarce in British Columbia.

Objectives:

This study aimed to (1) aid miscarriage recovery through the identification and sharing of equitable pregnancy loss care practices and supports and (2) present policy recommendations to improve prenatal care guidelines and employment standards for pregnancy loss.

Design:

This research took a patient-oriented methodological approach alongside people with lived/living experience(s) of miscarriage recovery in British Columbia to evaluate access to health care during pregnancy loss, societal understanding of miscarriage, and treatment options that foreground dignity.

Methods:

The mixed-methods design of this research included policy research on prenatal care guidelines, policy research on provincial and territorial employment legislation for bereavement leave, semi-structured interviews (n = 27), and a discovery action dialogue (n = 4).

Results:

The findings of this research demonstrate the need for improved prenatal care guidelines for early pregnancy loss, follow-up care after a miscarriage, mental health screening and supports, and bereavement leave legislation.

Conclusion:

This article includes recommendations to improve equitable access to pregnancy loss care, bereavement leave legislation, and future research in this area.
Positive masculinity or toxic positivity? Apple TV+’s Ted Lasso as a capitalist utopia
Authors: Beare Alexander Hudson , Boucaut Robert
Published: January 2024

Ted Lasso (2020-present) follows American Football coach, Ted Lasso, as he transforms the waning English Premier League team, AFC Richmond, through his relentless optimism and his mantra of ‘believe’. The show has been praised by critics for its emphasis on kindness and particularly for its exploration of ‘positive’ and ‘vulnerable’ masculinities. It is placed front and centre not just in promotion for Apple TV+ but also for the broader Apple brand which is heavily integrated into the show’s storyworld. Through a textual analysis of the series, this article critically examines Ted Lasso’s representations of masculinity and homophobia within the context of professional football. We argue that Ted Lasso subtly replicates the corporate identity of Apple in which real-world issues are selectively harnessed and distorted to create a utopic world-vision. Despite a celebrated veneer of ‘positive masculinities’ the show still exists in service of a sporting culture that is overtly steeped in hypermasculinity. Instead of challenging sports-based homophobia as it exists in the real-world, the show minimizes its existence at the (almost total) expense of including gay characters and storylines. In ‘dismantling’ toxic masculinity through such shallow means, we contend that Ted Lasso is ultimately symptomatic of a show sublimating its narrative wants to Apple’s corporate needs.
Psychotropic prescribing after hospital discharge in survivors of critical illness, a retrospective cohort study (2012–2019)
Authors: Mansi Elizabeth T , Rentsch Christopher T , Bourne Richard S , Guthrie Bruce , Lone Nazir I
Published: January 2024

Background:

Many people survive critical illness with the burden of new or worsened mental health issues and sleep disturbances. We examined the frequency of psychotropic prescribing after critical illness, comparing critical care to non-critical care hospitalised survivors, and whether this varied in important subgroups.

Methods:

This retrospective cohort study included 23,340 critical care and 367,185 non-critical care hospitalised adults from 2012 through 2019 in Lothian, Scotland, who survived to discharge.

Results:

One-third of critical care survivors (32%; 7527/23,340) received a psychotropic prescription within 90 days after hospital discharge (25% antidepressants; 14% anxiolytics/hypnotics; 4% antipsychotics/mania medicines). In contrast, 15% (54,589/367,185) of non-critical care survivors received a psychotropic prescription (12% antidepressants; 5% anxiolytics/hypnotics; 2% antipsychotics/mania medicines). Among patients without psychotropic prescriptions within 180 days prior to hospitalisation, after hospital discharge, the critical care group had a higher incidence of psychotropic prescription (10.3%; 1610/15,609) compared with the non-critical care group (3.2%; 9743/307,429); unadjusted hazard ratio (HR) 3.39, 95% CI: 3.22–3.57. After adjustment for potential confounders, the risk remained elevated (adjusted HR 2.03, 95% CI: 1.91–2.16), persisted later in follow-up (90–365 days; adjusted HR 1.38, 95% CI: 1.30–1.46), and was more pronounced in those without recorded comorbidities (adjusted HR 3.49, 95% CI: 3.22–3.78).

Conclusions:

Critical care survivors have a higher risk of receiving psychotropic prescriptions than hospitalised patients, with a significant proportion receiving benzodiazepines and other hypnotics. Future research should focus on the requirement for and safety of psychotropic medicines in survivors of critical illness, to help guide policy for clinical practice.
Treatment options for HER2-expressing colorectal cancer: updates and recent approvals
Authors: Zheng-Lin Binbin , Bekaii-Saab Tanios S.
Published: January 2024

Colorectal cancer is a leading cause of cancer-related mortality worldwide. Approximately 3–5% of colorectal tumors harbor human epidermal growth factor receptor ( HER2) amplification which is associated with a higher incidence of intracranial metastasis and overall worse outcomes. In the setting of refractory metastatic RAS wild-type tumors, evidence supports the use of various HER2-blocking agents, including monoclonal antibodies, tyrosine kinase inhibitors, and novel antibody–drug conjugates. With a number of relatively active agents clinically available and even more in development, it is crucial for clinicians to familiarize themselves with the mechanisms of action, efficacy data, and safety profiles of these treatments. In this review, we aim to summarize key findings from past and ongoing trials with anti-HER2 agents in metastatic colorectal cancer.
When Does (Mis)Fit Between Customer Service Orientation and Internal Service Qualities Matter for Frontline Employees’ Pride in Membership and Their Behaviors?
Authors: Yongho Hyun Martin , Gao Lisa , Lee Seoki , Kim Hyeon-Cheol
Published: January 2024

The literature has paid little attention to the (mis)fit effect between customer service orientation (CSO) and internal service qualities (ISQ). Unlike past studies, we use a non-commensurate and complementary fit approach by adopting a distinctive CSO as a need dimension at the individual level and ISQ as a satisfaction dimension provided by the organization. We test a CSO–ISQ (mis)fit model and include pride in membership and internal ethics training programs as supplementary activators for frontline employee turnover intentions and affective commitment. Based on the polynomial, mediation, and moderation analyses, we found that enjoyment service orientation–ISQ (mis)fit effects on pride in membership show complete and partial mediation effects on turnover intentions and affective commitment, with a significant joint effect of the training program. We discuss the theoretical contributions of our findings. Findings suggest that enhancing pride in membership can buffer the misfit between frontline employees’ needs and their satisfaction with ISQ, leading to a lower turnover intention and a stronger affective commitment. Furthermore, this study suggests that internal ethics training programs can enhance the positive effect of pride in membership on turnover intentions and affective commitment.
Patient-caregiver twinned mobile phone application to promote medication adherence
Authors: Tan NC , Goh CC , Koh YLE , Tan SFI , Ponraj D , Luo ZQ
Published: January 2024

Background

Poor medication adherence (MA) is prevalent globally. MA assessment, often based on scales or pill count, lacks actionability. A mobile application (app), MediEasy, targeting patients on multiple daily medications, has been developed to engage their caregivers to enhance their MA.

Objectives

This pilot single-arm study aimed to determine the feasibility, acceptability, utility and glycaemic control of the MediEasy-app by patients with type-2 diabetes mellitus and their caregivers.

Methods

20 Multi-ethnic Asian patients aged 51 to 70 years with suboptimal glycaemic control (HbA1c>7.5%) and their caregivers were recruited at a Primary care outpatient clinic in Singapore. The Medieasy app that contains the following major functionalities such as the alerts to take medications, embedded medication details, personalized dosing options (such as frequency and scheduling dosage settings) is twinned to their designated caregivers. The Caregivers can remind the patients who missed the scheduled medication intake when the paired device was alerted.

Results

85% (17/20) of the participants used the app for the entire 4 weeks, reflecting feasibility; 3 dropped out due to technical glitches or failure to adhere to protocol. The app was activated with an average of 2.8 times per day showing adequate utility. The 17 participants and their caregivers agreed that the app supported medication adherence. Their mean HbA1c decreased by 0.2% after 12 weeks of app usage.

Conclusions

The results showed feasibility, utility and acceptability of the MediEasy-app, with improved glycaemic control after its usage.
Strain-induced bands of Büngner formation promotes axon growth in 3D tissue-engineered constructs
Authors: Hromada Carina , Szwarc-Hofbauer Dorota , Quyen Nguyen Mai , Tomasch Janine , Purtscher Michaela , Hercher David , Teuschl-Woller Andreas Herbert
Published: January 2024

Treatment of peripheral nerve lesions remains a major challenge due to poor functional recovery; hence, ongoing research efforts strive to enhance peripheral nerve repair. In this study, we aimed to establish three-dimensional tissue-engineered bands of Büngner constructs by subjecting Schwann cells (SCs) embedded in fibrin hydrogels to mechanical stimulation. We show for the first time that the application of strain induces (i) longitudinal alignment of SCs resembling bands of Büngner, and (ii) the expression of a pronounced repair SC phenotype as evidenced by upregulation of BDNF, NGF, and p75NTR. Furthermore, we show that mechanically aligned SCs provide physical guidance for migrating axons over several millimeters in vitro in a co-culture model with rat dorsal root ganglion explants. Consequently, these constructs hold great therapeutic potential for transplantation into patients and might also provide a physiologically relevant in vitro peripheral nerve model for drug screening or investigation of pathologic or regenerative processes.
Efficacy of compliance with ventilator-associated pneumonia care bundle: A 24-month longitudinal study at Bach Mai Hospital, Vietnam
Authors: Hoang Hoan Minh , Dao Co Xuan , Huy Ngo Hoang , Okamoto Tatsuya , Matsubara Chieko , Do Son Ngoc , Bui Giang Thi-Huong , Bui Han Quang , Duong Nguỵen Thi , Nguyen Ngoan Thi , Vuong Toan Xuan , Van Vu Kham , Phạm Thach The , Van Bui Cuong
Published: January 2024

Introduction:

To decrease the risk of complications from ventilator-associated pneumonia, it is essential to implement preventative measures in all ICU patients. Since 2018, with the help of Japanese experts, we have applied a ventilator-associated pneumonia care bundle with 10 basic standards in patient care and monitoring. Therefore, we conducted a study to evaluate the results of applying 10 solutions to prevent ventilator-associated pneumonia over 24 months.

Methods:

A cross-sectional descriptive study with longitudinal follow-up for 24 months on 170 mechanically ventilated patients at the Center for Critical Care Medicine, Bach Mai Hospital. According to the Centers for Disease Control (CDC, 2021), the diagnosis of ventilator-associated pneumonia is when pneumonia appears 48 h after intubation by confirmation by at least two doctors. Evaluate compliance with each solution in the care bundle through camera monitoring, medical records, and directly on patients daily.

Results:

The rate of ventilator-associated pneumonia is 12.9%, the frequency of occurrence is 16.54 of 1000 days. The compliance rate for complete compliance with a 10-item ventilator-associated pneumonia was only 1.8%, while the average value was 84.1%. Average values of compliance with each solution for hand hygiene, head elevation 30–45 degrees, oral hygiene, stopping sedation, breathing circuit management, cuff pressure management, hypoplastic suction, Spontaneous breathing trial (SBT) daily and assessed extubation, mobilization and early leaving bed, ulcer and thrombosis prevention were 96.9%, 97.3%, 99.4%, 81.5%, 99.9%, 99.9%, 86.3%, 83.5%, 49.3%, and 46.4%, respectively. The time to appear ventilator-associated pneumonia in the high compliance group was 46.7 ± 5.0 days, higher than in the low compliance group, 10.3 ± 0.7 days, p < 0.001.

Conclusions:

A 10-item ventilator-associated pneumonia care bundle has helped reduce the incidence of ventilator-associated pneumonia. To reduce the risk of ventilator-associated pneumonia and shorten ICU and hospital stays, it is essential to fully adhere to subglottic secretion suction, daily SBT, and early mobilization and leaving the bed.
Sociological studies on Chinese religion since the turn of the century
Authors: Lu Yunfeng , Sheng He
Published: January 2024

This paper reviews research on the sociology of religion in China since the beginning of the new century. In terms of theoretical research, there are three main themes: first, research focusing on C. K. Yang's sociological study on religion, especially the theories of diffused religion and institutional religion; second, the dialogue with forefront issues such as the application of and controversies related to the rational choice theory of religion in China; and third, indigenous theoretical constructs, including “religious ecology theory” and the theory of the “Sinicization of religion”. In terms of quantitative research, this article reviews progress in the measurement of Chinese religiosity.
Reduction of Postoperative Delirium and Opioid Use in Hip Fracture Patients Through Utilization of Emergency Department Physician Administered Regional Nerve Blocks
Authors: Snapp Cathy , Byrd Brandon , Porter Michael
Published: January 2024

Introduction

The complication of delirium for hip fracture patients is a predictor of mortality. Use of opioid medication increases the incidence of delirium in the pre- and postoperative periods. Regional nerve blocks are effective in managing acute pain for acute hip fractures. This study aims to evaluate the utilization of ED physicians to perform fascia iliaca nerve blocks on hip fracture patients to decrease the incidence of delirium by decreasing usage of opioid medication.

Methods

A quality improvement project for performing regional nerve blocks on patients with femoral neck fractures was implemented during fiscal year 2019. Data was collected retrospectively for frequency of ED nerve block procedures, amount of opioid medication use, and incidence of delirium in patients diagnosed with hip fracture. This data was compared to baseline data to determine success of the intervention.

Results

Utilization of regional nerve blocks in the ED increased from 2% in 2018 to 96% in 2021 and 89% in 2022. Preoperative opioid usage decreased from 38 MMEs to 16.9 and 18 MMEs respectively. Daily average MMEs decreased from 34 to 12.1 and 14 respectively. Postoperative delirium decreased from 6% in 2018 to 0% from 2020 to 2022.

Discussion

ED provider administration of fascia iliaca blocks and follow-up is a novel practice in our region to decrease the adverse effects of opiate use and decrease delirium rates. There was a reduction in length of stay and increased discharge home rate despite the Covid-19 pandemic.

Conclusion

Administration of regional nerve blocks by ED physicians to hip fracture patients presenting to the ED results in a decrease in opioid medication usage. This also results in a decreased delirium rates in the hip fracture patient population.
Impostorization in Academia, Psychological Distress, and Class Reproduction
Authors: Phelan Jo
Published: January 2024

Might “impostor syndrome” be more than the private trouble it is often described to be? Instead, might it be deeply rooted in sociological processes? I explore this possibility drawing on my personal experience and Pearlin’s insistence that much that distresses us in our personal lives originates in social structures. I use Bourdieu’s theory to conceptualize the processes that may instill the “syndrome,” and once in place, surreptitiously recreate inequality. I test this conceptualization, using new sociologically relevant measures, in a stratified sample of over 2,000 American college students. Experiencing impostor concerns in college was significantly related to low parental income. Results were consistent with a model in which impostor concerns mediate the association of low parental income to depression/anxiety and low college persistence. Cultural aspects of impostorization played a larger role than the intellectual aspects emphasized in the traditional conceptualization of impostor syndrome. I advocate the replacement of the within-the-person term “impostor syndrome” with the sociological term “impostorization.”
Investigating the Washback of the Chinese Language Proficiency Test (HSK): From the Perspective of CSL Students
Authors: Kong Fuyu , Zhang Yanli
Published: January 2024

To explore the washback of the HSK on students learning Chinese as a Second Language (CSL), the study surveyed 1,616 SCL students from 25 different mother tongue backgrounds and interviewed international students studying in China through questionnaire and interview. The following was found in this study: (a) The HSK influenced both the process and results of CSL learning, and the positive impact outweighed the negative impact. (b) Students’ motivation and perception of the HSK were the key factors that influenced the level of HSK washback. (c) The HSK had different intensities of washback on students at different HSK levels, with the strong effect on students at the lower level and a weak effect on students at the higher level. Based on the findings, some implications and suggestions for learners, teachers and test designers are provided.
Comparison of Posterior Approach and Combined Anterior-Posterior Approach in the Treatment of Ankylosing Spondylitis Combined With Cervical Spine Fracture: A Systematic Review and Meta-Analysis
Authors: Peng Cong , Luan Haopeng , Liu Kai , Song Xinghua
Published: January 2024

Study Design

Systematic review.

Objective

To compare the efficacy of the posterior approach and combined anterior-posterior approach in the treatment of ankylosing spondylitis (AS) with cervical spine fracture by meta-analysis.

Methods

The databases PubMed, Web of Science, Embase, and Cochrane Library were searched for studies on the comparison of the posterior approach group and the combined anterior-posterior approach group in the treatment of ankylosing spondylitis combined with cervical spine fracture from database establishment to August 2023. The procedure time, intraoperative blood loss, the rates of neurological improvement, mean change in the postoperative neurological function, complication rates, rates of revised surgery, and mortality were extracted. Meta-analysis was performed using RevMan 5.4 software provided by Cochrane Library.

Results

A total of 11 retrospective cohort studies with a total of 215 patients were included in this study. The posterior approach group had lower intraoperative blood loss than the combined anterior-posterior approach group [Mean difference (MD) = -146.05, 95%CI(-187.40,-104.69), P < .00001]; the operation time was significantly less in the posterior approach group than in the combined anterior-posterior approach group [MD = -95.34, 95%CI(-113.13,-77.55), P < .00001]. There were no statistically significant differences in the neurological improvement rates, mean changes in postoperative neurological function, complication rates, modified surgery rates, and mortality rates.

Conclusion

Both the posterior approach and combined anterior and posterior approach can achieve good results. Clinicians should develop an individualized approach based on the patient's fracture type, degree of spinal cord injury, fracture stability, fracture dislocation, general condition, and underlying disease.
Isolated Biangular Fracture of the Mandible: A Rare Entity
Authors: Gehlot Neelima , Gupta D. S. , Singh Snigdha , Pillai Sooraj S. , Saini Deepika
Published: January 2024

Fractures of the lower jaw bone come with a unique set of challenges due to their effects on the overall health of the individual. An untreated jaw fracture can lead to malunion, which can ultimately affect the neuro-muscular-occlusal coordination of the masticatory unit. The fractures of the non-dentate regions of the mandible are difficult to manage conservatively, especially in the angle region, due to various muscular activities. The difficulty is coupled when the fracture is present bilaterally, and an exclusive treatment modality should be devised on a case-by-case basis. Bilateral angle fractures of the mandible are rare occurrences and are seldom reported compared to unilateral angle fractures. The difficulty in access and the presence of three unstable fragments and third molars in this region warrant the special attention of the surgeon in devising the treatment plan. For effective management of bilateral angle fractures, surgeons require in-depth knowledge of the biomechanics and anatomy of the jaw bones. This article reports a rare case of isolated bilateral angle fracture management post-road traffic accident in a young patient with rigid internal fixation using an intraoral and transbuccal approach.
Orthodontic-surgical Management of the Horizontal Unilateral Condylar Hyperplasia
Authors: Antonio Vernucci Roberto , Kelly Gardini , Melissa Panetta , Valentina Mazzoli , Alessandra Impellizzeri , Piero Cascone , Roberto Di Giorgio , Ersilia Barbato , Gabriella Galluccio
Published: January 2024

Introduction:

To describe the orthodontic-surgical approach we used in a sample of patients affected by the horizontal type of Unilateral Condylar Hyperplasia (UCH), that is a progressive disease that leads to mandibular asymmetry and midline deviation.

Material and Methods:

A retrospective observational cohort study was designed on 29 consecutive patients affected by horizontal UCH (23 females, 6 males; mean age, 22.4 y.o. ± 7.9) treated in the Units of Orthodontics and Maxillo-Facial Surgery. Descriptive statistics was performed. Correlations were tested between type of surgery and stage of skeletal maturation, presence of Temporo-mandibular Disorders, and condylar activity, evaluated with SPECT. Duration was correlated with type of surgery, and the mean duration of therapy was compared between patients who underwent condylectomy and those who underwent orthognathic surgery.

Results:

Females were more affected than males and had higher mean age. Temporo-mandibular Disorders were present in 31% of the sample. All patients with positive SPECT (15) were treated with condylectomy, alone or associated with orthognathic surgery, followed by post-surgical orthodontics. Patients with negative SPECT were treated with orthognathic surgery if adult (12), condylectomy if in age of skeletal growth (2).

Discussion:

The choice of the therapeutic approach has depended on skeletal maturation, condylar activity, and extent of dental compensations. Early condylectomy eliminates the etiologic cause of the Hyperplasia in patients with active condylar growth. In patients in age of growth, either if positive or negative to SPECT, early TMJ surgery eliminates the asymmetric growth and leads to symmetrization of the mandibular growth rate, acting as interceptive treatment.
Endocrinology/Primary Care Pharmacy Collaboration vs Endocrinology Care Alone in Patients With Type 2 Diabetes and A1c >9%
Authors: Fornwald Courtney R. , Russo-Alvarez Giavanna , Pantalone Kevin M. , Zeleznikar Elizabeth , Parker Marcie , McCorkindale Nicole , Butler Robert , Hermiller Taylor
Published: January 2024

Background: Type 2 diabetes (T2D) requires close collaboration between patients and their care management team, often including endocrinology. Primary care pharmacist impact on diabetes management in collaboration with endocrinology is not well established. Objective: To assess if pharmacy and endocrinology collaboration results in a greater A1c reduction in patients with T2D vs endocrinology alone. Methods: This retrospective, observational cohort study was conducted in adult outpatients with T2D and baseline A1c >9% who saw endocrinology within 1 year preceding the study period (January 1, 2021 to January 1, 2022). Patients were included if they had a follow-up A1c 6 months (±90 days) from index date and completed at least 1 endocrinology visit during the study period. Patients managed by endocrinology/primary care pharmacist collaboration (Endo/PharmD) were compared with those who received endocrinology care alone (Endo). Primary outcome was change in A1c from baseline to 6 months. Secondary outcomes included total number of completed visits and percentage of patients achieving A1c <6.5%, <7%, <8%, and <9% between groups at 6 months. Results: A total of 418 patients were included (22 Endo/PharmD, 396 Endo). The change in follow-up A1c was not significantly different between groups, −0.481% (standard error [SE] = 0.396); P = 0.6179. Endo/PharmD patients had significantly more provider visits during the study period (5.3 ± 2.3 vs 2.3 ± 1.2; P < 0.001). No significant difference was observed in odds of A1c goal attainment between groups at 6 months. Conclusion and Relevance: Endocrinology/primary care pharmacist collaboration occurred infrequently but was associated with a trend toward greater A1c reduction in patients with T2D and A1c >9%.
Targeting IDH2R140Q and other neoantigens in acute myeloid leukemia
Authors: Leung Wingchi K. , Torres Chavez Alejandro G. , French-Kim Matthew , Shafer Paul , Mamonkin Maksim , Hill LaQuisa C. , Kuvalekar Manik , Velazquez Yovana , Watanabe Ayumi , Watanabe Norihiro , Hoyos Valentina , Lulla Premal , Leen Ann M.
Published: January 2024

For patients with high-risk or relapsed/refractory acute myeloid leukemia (AML), allogeneic stem cell transplantation (allo-HSCT) and the graft-versus-leukemia effect mediated by donor T cells, offer the best chance of long-term remission. However, the concurrent transfer of alloreactive T cells can lead to graft-versus-host disease that is associated with transplant-related morbidity and mortality. Furthermore, ∼60% of patients will ultimately relapse after allo-HSCT, thus, underscoring the need for novel therapeutic strategies that are safe and effective. In this study, we explored the feasibility of immunotherapeutically targeting neoantigens, which arise from recurrent nonsynonymous mutations in AML and thus represent attractive targets because they are exclusively present on the tumor. Focusing on 14 recurrent driver mutations across 8 genes found in AML, we investigated their immunogenicity in 23 individuals with diverse HLA profiles. We demonstrate the immunogenicity of AML neoantigens, with 17 of 23 (74%) reactive donors screened mounting a response. The most immunodominant neoantigens were IDH2R140Q (n = 11 of 17 responders), IDH1R132H (n = 7 of 17), and FLT3D835Y (n = 6 of 17). In-depth studies of IDH2R140Q-specific T cells revealed the presence of reactive CD4+ and CD8+ T cells capable of recognizing distinct mutant-specific epitopes restricted to different HLA alleles. These neo–T cells could selectively recognize and kill HLA-matched AML targets endogenously expressing IDH2R140Q both in vitro and in vivo. Overall, our findings support the clinical translation of neoantigen–specific T cells to treat relapsed/refractory AML.
Oligoribonuclease mediates high adaptability of P. aeruginosa through metabolic conversion
Authors: Yang Lulu , Wang Lili , Wang Mengyu , Bajinka Ousman , Wu Guojun , Qin Ling , Tan Yurong
Published: January 2024

Background

Oligoribonuclease (orn) of P. aeruginosa is a highly conserved exonuclease, which can regulate the global gene expression levels of bacteria through regulation of both the nanoRNA and c-di-GMP. NanoRNA can regulate the expression of the bacterial global genome as a transcription initiator, and c-di-GMP is the most widely second messenger in bacterial cells.

Objective

This study seeks to elucidate on the regulation by orn on pathogenicity of P. aeruginosa.

Methods

P. aeruginosa with orn deletion was constructed by suicide plasmid homologous recombination method. The possible regulatory process of orn was analyzed by TMT quantitative labeling proteomics. Then experiments were conducted to verify the changes of Δorn on bacterial motility, virulence and biofilm formation. Bacterial pathogenicity was further detected in cell and animal skin trauma models. ELISA detection c-di-GMP concentration and colony aggregation and biofilm formation were observed by scanning electron microscope.

Results

orn deletion changed the global metabolism of P. aeruginosa and reduced intracellular energy metabolism. It leads to the disorder of the quorum sensing system, the reduction of bacterial motility and virulence factors pyocyanin and rhamnolipids. But, orn deletion enhanced pathogenicity in vitro and in vivo, a high level of c-di-GMP and biofilm development of P. aeruginosa.

Conclusion

orn regulates the ability of P. aeruginosa to adapt to the external environment.