bluuebunny/crossref_metadata_2025 huggingface dataset:
Adenoidectomy Without Tonsillectomy for Pediatric Obstructive Sleep Apnea
Authors: Chorney Stephen R. , Zur Karen B.
Published: September 2020

Objective

The primary objective was to determine if obstructive sleep apnea (OSA) can improve after adenoidectomy.

Study Design

Case series with chart review.

Setting

Tertiary children’s hospital between 2016 and 2018.

Methods

The study included children under 3.5 years with small (1+ or 2+) palatine tonsils, large (3+ or 4+) adenoids, and documented OSA on polysomnogram (PSG).

Results

Seventy‐one children were included. Age at adenoidectomy was 2.0 years (95% CI, 1.8‐2.2) and 71.8% were male. Mean follow‐up was 2.5 years (95% CI, 2.3‐2.7). Twenty‐six children (36.6%) obtained a repeat PSG at a mean of 9.7 months (95% CI, 6.3‐13.2) after adenoidectomy. Among those with a postoperative PSG, apnea‐hypopnea index decreased in 77.0% (mean, –3.2 events/h; 95% CI, –14.1 to 7.6), and the proportion with moderate to severe OSA decreased from 65.4% to 30.8% (P =. 03). Six children (23.1%) had a normal PSG after adenoidectomy. Tonsillectomy was performed in 14.1% of children at 12.1 months (95% CI, 7.5‐16.7) after adenoidectomy. Despite similar preoperative PSG variables, younger children (1.5 vs 2.1 years, P =. 02) were more likely to require tonsillectomy. Substantial adenoid regrowth was identified in 1 child at the time of tonsillectomy.

Conclusion

Adenoidectomy may improve OSA in young children with large adenoids and small tonsils. However, younger age predicted the need for subsequent tonsillectomy. Prospective studies with additional PSG data are necessary to corroborate these findings.
Truncal vs Branch Ligation of Inferior Thyroid Arteries in Total Thyroidectomy: Does It Affect Postoperative Hypoparathyroidism?
Authors: Waseem Talat , Ahmed Safia Zahir , Baig Hadia , Ashraf Muhammad Hasham , Azim Asad , Azim Khawaja M.
Published: September 2020

Objective

Postthyroidectomy hypoparathyroidism remains a significant challenge. Truncal ligation of the inferior thyroid arteries (ITAs) may lead to an increased risk of hypoparathyroidism; however, dissection along the thyroid capsule with branch ligation of the thyroid arteries could be a safer option. This study’s objective was to compare the effect of truncal versus branch ligation of the ITAs on the rate of postoperative hypoparathyroidism.

Study Design

Randomized prospective trial in line with the CONSORT guidelines.

Setting

The study was conducted at a high‐volume tertiary care setting.

Methods

We randomized 319 patients into 2 groups: truncal ITA ligation (n = 157) and branch ITA ligation (n = 162). The primary outcomes were serum calcium and parathormone levels on the second postoperative day, followed by the levels on months 1, 3, 6, and 12. The need for exogenous replacements was noted. The secondary outcomes, such as operative time, blood loss, and other complications, were also recorded.

Results

Our study revealed a significant difference in the incidence of transient hypocalcemia in patients undergoing truncal ITA ligation and branch ITA ligation (22.9% vs 3.1%, P <. 05). The results showed that the levels of serum calcium and parathormone dropped on the second postoperative day and that 36 patients from the truncal ITA ligation group required exogenous calcium and vitamin D replacement. In contrast, only 5 patients from the branch ITA ligation group required the same.

Conclusions

This is the largest randomized trial of patients undergoing thyroidectomy, and it shows that dissection along the thyroid capsule with branch ligation of the ITAs is more likely to preserve parathyroid function as opposed to truncal ligation of ITAs.
A Model for Undergraduate Medical Student Education in Otolaryngology During the Post–COVID‐19 Era
Authors: Wickemeyer Johanna L. , Yu Jeffrey
Published: September 2020

The clinical learning environment is limited for undergraduate medical education in otolaryngology as the result of coronavirus disease 2019. In an effort to foster and rebuild the attending–medical student relationship, we have developed the R4 teaching model. This model encourages the student to read background information, respond to questions, and review online with faculty with the goal of realization of clinical decision making with gained knowledge. Within the R4 model, there are learning environment subtypes, including real patient cases, journal club, interactive quizzes, flipped classroom, and attending‐lead discussions. In the absence of a multitude of “live” patients, our curricula reinstate the core of clinical teaching for medical students.
Resumption of Otolaryngology Surgical Practice in the Setting of Regionally Receding COVID‐19
Authors: Izreig Said , Zogg Cheryl K. , Kasle David A. , Torabi Sina J. , Manes R. Peter
Published: September 2020

The practice of otolaryngology has been drastically altered as a consequence of the ongoing coronavirus disease 2019 (COVID‐19) pandemic. Geographic heterogeneity in COVID‐19 burden has meant different regions have experienced the pandemic at different stages. Regional dynamics of COVID‐19 incidence has dictated the available resources for the provision of surgical care. As regions navigate their own COVID‐19 dynamics, illustrative examples of areas affected early by the COVID‐19 pandemic may provide anticipatory guidance. In this commentary, we discuss our experience with performed and canceled surgical procedures across the various otolaryngology specialties at our institution over the course of regionally rising and falling incident COVID‐19 cases.
Multidisciplinary Safety Recommendations After Tracheostomy During COVID‐19 Pandemic: State of the Art Review
Authors: Meister Kara D. , Pandian Vinciya , Hillel Alexander T. , Walsh Brian K. , Brodsky Martin B. , Balakrishnan Karthik , Best Simon R. , Chinn Steven B. , Cramer John D. , Graboyes Evan M. , McGrath Brendan A. , Rassekh Christopher H. , Bedwell Joshua R. , Brenner Michael J.
Published: September 2020

Objective

In the chronic phase of the COVID‐19 pandemic, questions have arisen regarding the care of patients with a tracheostomy and downstream management. This review addresses gaps in the literature regarding posttracheostomy care, emphasizing safety of multidisciplinary teams, coordinating complex care needs, and identifying and managing late complications of prolonged intubation and tracheostomy.

Data Sources

PubMed, Cochrane Library, Scopus, Google Scholar, institutional guidance documents.

Review Methods

Literature through June 2020 on the care of patients with a tracheostomy was reviewed, including consensus statements, clinical practice guidelines, institutional guidance, and scientific literature on COVID‐19 and SARS‐CoV‐2 virology and immunology. Where data were lacking, expert opinions were aggregated and adjudicated to arrive at consensus recommendations.

Conclusions

Best practices in caring for patients after a tracheostomy during the COVID‐19 pandemic are multifaceted, encompassing precautions during aerosol‐generating procedures; minimizing exposure risks to health care workers, caregivers, and patients; ensuring safe, timely tracheostomy care; and identifying and managing laryngotracheal injury, such as vocal fold injury, posterior glottic stenosis, and subglottic stenosis that may affect speech, swallowing, and airway protection. We present recommended approaches to tracheostomy care, outlining modifications to conventional algorithms, raising vigilance for heightened risks of bleeding or other complications, and offering recommendations for personal protective equipment, equipment, care protocols, and personnel.

Implications for Practice

Treatment of patients with a tracheostomy in the COVID‐19 pandemic requires foresight and may rival procedural considerations in tracheostomy in their complexity. By considering patient‐specific factors, mitigating transmission risks, optimizing the clinical environment, and detecting late manifestations of severe COVID‐19, clinicians can ensure due vigilance and quality care.
Imaging evaluation using computed tomography after ascending aortic graft repair
Authors: Raju Sreenivasa Narayana , Shaw Manish , Pandey Niraj Nirmal , Sharma Arun , Kumar Sanjeev
Published: September 2020

Prosthetic aortic graft repair is employed in the management of various conditions such as annuloaortic ectasia, ascending aortic aneurysm, type A aortic dissection, and aortic root abscess. Correct interpretation of post-surgical prosthetic graft complications requires familiarity with the expected normal cross-sectional imaging appearance as well knowledge of additional surgical materials used in the repair, which could influence the imaging appearance. Multiple life-threatening complications of a prosthetic ascending aortic graft can be seen in the aorta and vicinity of the operative field. Complications can arise from involvement of the prosthetic aortic graft per se or secondary involvement of the coronary arteries, mediastinum, and sternotomy site. The optimal imaging protocol using multidetector computed tomography allows accurate interpretation of the expected benign postoperative changes as well as complications associated with the prosthetic graft, and differentiation of true complications from their mimickers. This review focuses on the normal imaging appearance of a prosthetic aortic graft on multidetector computed tomography, and imaging evaluation of multiple post-surgical complications that could arise after repair of the ascending aorta and the aortic valve.
Market Development and Value Creation for Low Socioeconomic Segments in Emerging Markets: An Integrated Perspective Using the 4A Framework
Authors: Maity Moutusy , Singh Ramendra
Published: September 2020

This article uses the 4A framework (awareness, acceptability, affordability, accessibility) to examine the impact of marketing activities on market development (i.e., access to markets, access to people) and value creation (financial value and relationship value) in low-income segments in emerging markets. Using cross-national survey data spanning mobile phone users in five emerging Asian markets (countries: Bangladesh, India, Pakistan, Sri Lanka, and Thailand), the study findings provide empirical support for the 4A framework for small farmers and business persons (i.e., low-income entrepreneurs) in these markets. The study uniquely contributes to the base of pyramid literature in emerging markets since the 4A marketing framework has not been studied for its effectiveness on micro-entrepreneurs so far. This article also contributes to research and practice by showing how market development and value creation go hand-in-hand for micro-entrepreneurs in emerging markets.
Brand Externalities: A Taxonomy
Authors: Padela Shoaib M. Farooq , Wooliscroft Ben , Ganglmair-Wooliscroft Alexandra
Published: September 2020

Brands are ubiquitous and adorn contemporary marketing systems. Modern branding practices spawn contradictory social mechanisms, value co-creation and value co-destruction. This paper considers the societal implications, including personal, psychological, social, ecological, and economic consequences of branding. It posits brand externalities as meaning-led discrepancies and symbolic spill-overs igniting mechanisms detrimental to the integrity of the social system. Brand externalities accompany the assortment of brands in contemporary marketing systems. We propose a taxonomy of brand externalities and elucidate societal consequences of branding upon brand exchange actors themselves, their immediate others, future others and general others. This stakeholder orientation sets a future research agenda and calls for redefining branding from the system’s perspective.
The Hebel World, Its Ambiguities and Contradictions
Authors: Goh Samuel T. S.
Published: September 2020

Drawing on the arguments that hebel is the thesis of Ecclesiastes as well as Qoheleth’s rhetorical tool, this essay examines hebel’s connection with Qoheleth’s ambiguities and contradictions. Understanding hebel in terms of its basic meaning, that is, vapour, we argue that Qoheleth employs the image as his rhetorical strategy because of its opaque and fluctuating character. Being opaque, hebel is an ideal symbol for delineating phenomena which are ambiguous and hard to define. Coupled with its capacity for infinite change, the opacity allows hebel semantic inexhaustibility, making it a versatile device for describing the fluctuating nature of reality. As everything is opaque and in constant change, Qoheleth cannot offer advice in absolute terms and often ends up making contradictory statements.
Structural improvement study of streamline design method, conical hub, and auxiliary blades for axial blood pump
Authors: Yu Zheqin , Tan Jianping , Wang Shuai , Guo Bin
Published: September 2020

The blood pump is a medical device used to assist or replace the diseased heart. Research on the structure of blood pumps has been committed to achieving better hemolysis and hydraulic performance. The purpose of this study was to find some effective ways to improve design methods and hydraulic structures. The research contents of improvement include: (1) improved blade streamline design method; (2) conical impeller hub; (3) additional auxiliary blades. Characteristic analysis and parameter design were carried out on the above three aspects. The methods used in this study included Dynamics (CFD) simulation, hydraulic experiments, and Particle Image Velocimetry (PIV) experiments. The results showed that this improved streamline design method could improve the distortion of blades and ensure a smaller impeller length. And, in the enhanced design of the hub, it is designed to be conical with inlet and outlet diameters of 7.5 and 12.8 mm, respectively. Furthermore, the auxiliary blades between the main blades are analyzed and designed. The results have the best performance optimization effect when the length of the auxiliary blades is 55% of the main blades. In general, the structural improvements in this study achieved the effect of improving hydraulic performance and avoiding increased hemolysis. These methods can be considered as an effective means of improving blood pump performance.
The Association between the Perceived Adequacy of Workplace Infection Control Procedures and Personal Protective Equipment with Mental Health Symptoms: A Cross-sectional Survey of Canadian Health-care Workers during the COVID-19 Pandemic: L’association entre le caractère adéquat perçu des procédures de contrôle des infections au travail et de l’équipement de protection personnel pour les symptômes de santé mentale. Un sondage transversal des travailleurs de la santé canadiens durant la pandémie COVID-19
Authors: Smith Peter M. , Oudyk John , Potter Guy , Mustard Cameron
Published: September 2020

Objectives:

To examine the relationship between perceived adequacy of personal protective equipment (PPE) and workplace-based infection control procedures (ICP) and mental health symptoms among a sample of health-care workers in Canada within the context of the current COVID-19 pandemic.

Methods:

A convenience-based internet survey of health-care workers in Canada was facilitated through various labor organizations between April 7 and May 13, 2020. A total of 7,298 respondents started the survey, of which 5,988 reported information on the main exposures and outcomes. Anxiety symptoms were assessed using the Generalized Anxiety Disorder (GAD-2) screener, and depression symptoms using the Patient Health Questionnaire (PHQ-2) screener. We assessed the perceived need and adequacy of 8 types of PPE and 10 different ICP. Regression analyses examined the proportion of GAD-2 and PHQ-2 scores of 3 and higher across levels of PPE and ICP, adjusted for a range of demographic, occupation, workplace, and COVID-19-specific measures.

Results:

A total of 54.8% (95% confidence interval [CI], 53.5% to 56.1%) of the sample had GAD-2 scores of 3 and higher, and 42.3% (95% CI, 41.0% to 43.6%) of the sample had PHQ-2 scores of 3 and higher. Absolute differences of 18% (95% CI, 12% to 23%) and 17% (95% CI, 12% to 22%) were observed in the prevalence of GAD-2 scores of 3 and higher between workers whose perceived PPE needs and ICP needs were met compared to those who needs were not met. Differences of between 11% (95% CI, 6% to 17%) and 19% (95% CI, 14% to 24%) were observed in PHQ-2 scores of 3 and higher across these same PPE and ICP categories.

Conclusions:

Our results suggest strengthening employer-based infection control strategies likely has important implications for the mental health symptoms among health-care workers in Canada.
Effects of the Anti-stigma Workplace Intervention “Working Mind” in a Canadian Health-Care Setting: A Cluster-Randomized Trial of Immediate Versus Delayed Implementation
Authors: Dobson Keith S. , Markova Veronika , Wen Alainna , Smith Laura M.
Published: September 2020

Objectives:

The Working Mind is a program designed to reduce stigmatizing attitudes toward mental illness, improve resilience, and promote mental health in the general workplace. Previous research has revealed positive program effects in a variety of workplace settings. This study advances previous work in implementing randomization and a control group to assess the intervention’s efficacy.

Methods:

The program was evaluated using a cluster-randomized design, with pretest, posttest, and a 3-month follow-up in 2 implementation groups across 4 sites.

Results:

The Working Mind program was effective at decreasing mental health stigma and increasing self-reported resilience and coping skills at the pre–post assessment in both delivery groups. The program’s effects were maintained to the time of 3-month follow-up. Qualitative data provided further evidence that participants benefited from the program.

Conclusions:

This study represents an advancement over past research and provides further support for efficacy of the Working Mind program. Directions for future research, including replication using rigorous methodological procedures and examination of program effects over longer follow-up intervals, are discussed.
Vacuum infusion in porous preform with different mould configurations: Flow simulation and experimental validation
Authors: Adhikari Debabrata , Gururaja Suhasini , Hemchandra Santosh
Published: September 2020

The present work focuses on the formulation of transient incompressible resin flow during vacuum-assisted resin transfer moulding using level set front tracking method in a multi-block structured grid within a finite difference framework. Initially, the relation between compaction pressure and fibre volume fraction ([Formula: see text]) has been established by conducting compression tests using a universal tensile machine under dry and wet conditions. In-plane permeability has been characterised as a function of [Formula: see text] using three thicknesses of unidirectional carbon fabric (4, 8 and 12 plies). A pressure data acquisition system and a non-contact out-of-plane displacement measurement setup have been developed using a single lens camera to conduct the vacuum infusion experiments. The numerical model prediction of the instantaneous change in pressure, displacement, and fill time has been validated with the experiments for the three different thickness of unidirectional preform in a flat plate and a plate with a centrally located hole during vacuum infusion. The coupled transient flow model with the level set interface propagation in a multi-block framework shows a good agreement with vacuum infusion experiments. The proposed transient vacuum infusion flow model, compaction relation with [Formula: see text], permeability and experimental setup show the potential to capture realistic flow physics during vacuum infusion on different mould configurations.
Reducing the Risk and Impact of Brachial Plexus Injury Sustained From Prone Positioning—A Clinical Commentary
Authors: Simpson Ashley I. , Vaghela Kalpesh R. , Brown Hazel , Adams Kate , Sinisi Marco , Fox Michael , Quick Tom
Published: September 2020

Introduction:

Prone positioning is deployed as a critical treatment for improving oxygenation in patients with Acute Respiratory Distress Syndrome. This regimen is currently highly prevalent in the COVID-19 pandemic. The pandemic has brought about increased concern about how best to safely avoid brachial plexus injuries when caring for unconscious proned patients.

Methods:

A review of the published literature on brachial plexus injuries secondary to proning ventilated patients was performed. This was combined with a review of available international critical care guidelines in order to produce a succinct set of guidelines to aid critical care departments in reducing brachial plexus injuries during these challenging times.

Discussion:

There is no one manner in which prone positioning an unconscious patient can be made universally safe. This paper provides 6 key steps to reducing the incidence of brachial plexus injuries while proning and suggests a safe and sensible management and referral pathway for the conscious patient in which a brachial plexus injury is identified.

Conclusion:

There is in truth no completely safe position for every patient and certainly there will be anomalies in anatomy that will predispose certain individuals to nerve injury. Thus the injury rate cannot be reduced to zero but an understanding of the principles of protection will inform those undertaking positioning.
In vitro characterization of xeno-free clinically relevant human collagen and its applicability in cell-laden 3D bioprinting
Authors: Schmitt Trevor , Kajave Nilabh , Cai Huan Huan , Gu Linxia , Albanna Mohammad , Kishore Vipuil
Published: September 2020

Collagen type I, commonly derived from xenogenic sources, is extensively used as a biomaterial for tissue engineering applications. However, the use of xenogenic collagen is typically associated with species specific variation in mechanical, structural, and biological properties that are known to influence cellular response and remodeling. In addition, immunological complications and risks of disease transmission are also major concerns. The goal of this study is to characterize a new xeno-free human skin-derived collagen and assess its applicability as a bioink for cell-laden 3 D bioprinting. Four different concentrations of human collagen (i.e., 0.5 mg/mL, 1 mg/mL, 3 mg/mL and 6 mg/mL) were employed for the synthesis of collagen hydrogels. In addition, bovine collagen was used as a xenogenic control. Results from SDS-PAGE analysis showed the presence of α1, α2, and β chains, confirming that the integrity of type I human collagen is maintained post isolation. Polymerization rate and compressive modulus increased significantly with increase in the concentration of human collagen. When comparing two different sources of collagen, the polymerization rate of xenogenic collagen was significantly faster (p < 0.05) than human collagen while the compressive modulus was comparable. Raman spectroscopy showed a large peak in the Amide I band around 1600 cm−1, indicating a dense and supraorganized fibrillar structure in human collagen hydrogels. Conversely, Amide I band intensity for xenogenic collagen was comparable to that of Amide II and Amide III bands. Further, the use of 6 mg/mL human collagen as a bioink yielded 3 D printed constructs with high shape fidelity and cell viability. On the other hand, xenogenic collagen failed to yield stable 3 D printed constructs. Together, the results from this study provides an impetus for using human-derived collagen as a viable alternative to xenogenic sources for 3 D bioprinting of clinically relevant scaffolds for tissue engineering applications.
School Discipline as a Consequence of Violent Victimization in Adolescence: Understanding the Mediating Roles of Head Injury and Behavior
Authors: Loomis Alysse M. , Sonsteng-Person Melanie , Jaggers Jeremiah , Osteen Philip
Published: September 2020

Pathways from violence to head injury and poor long-term outcomes have been found among numerous populations, however, have not yet been widely examined with youth exposed to violence. Traumatic brain injuries (TBIs) are linked to a range of consequences salient to adolescent development and well-being, such as impulsivity, academic abilities, and emotional processing. This gap in research has led to a missed opportunity to understand the consequences of youth victimization, particularly within the academic setting. The current study examined whether head injury and problem behaviors mediate the relationships between victimization and suspension/expulsion using data from the Pathways to Desistance Study, a multi-site, longitudinal study of serious adolescent offenders age 14–18. A sample of male youth who had witnessed violence ( n = 1,094) reported a total score of victimization, number of early behavior problems (i.e., cheating, fighting, etc.), ever having a head injury (32.9%), and number of times suspended (adjusted M = 13.13; SD = 19.31) or expelled (adjusted M = 0.65; SD = 0.99). Structural equation modeling was used to examine direct and indirect pathways from victimization to suspension and expulsion through head injury and behavior. Direct pathways from victimization to school discipline were significant; indirect pathways mediated by only head injury were not significant, but indirect pathways through only problem behavior and through TBI and problem behavior were significant for both expulsion and suspension. Results suggest that youth who have been victimized are at higher risk for both suspension and expulsion and that this risk may be, in part, explained through increased head injury and problem behaviors. TBI screenings/services for violence-exposed youth and trauma-informed school-based services may help to deter trajectories toward suspension and expulsion but should be developed with attention to the influence of racial bias on pathways to school discipline.
Association Between Registered Sex Offender Status and Risk of Housing Instability and Homelessness among Veterans*The contents of this article do not necessarily represent the views of the Department of Veterans Affairs or the US government.
Authors: Byrne Thomas , Cashy John , Metraux Stephen , Blosnich John R. , Cusack Meagan , Culhane Dennis P. , McInnes D. Keith , Culhane Emmett , Montgomery Ann Elizabeth
Published: September 2020

Research is limited about whether and to what extent registered sex offenders (RSOs) face an increased risk of housing instability. The intersection of RSO and housing instability is particularly salient for veterans as there are disproportionately higher rates of veterans among both RSOs and homeless populations. This study assessed the relationship between RSO status and risk of housing instability and homelessness among military veterans. We matched a list of 373,774 RSOs obtained from publicly available sex offender registries in 19 states with a cohort of 5.9 million veterans who responded to a brief screening for housing instability administered throughout the Veterans Health Administration between 2012 and 2016. Logistic regression estimated adjusted odds of any housing instability and homelessness among veterans identified as RSOs. Veterans identified as RSOs had 1.81 (95% confidence interval [CI] 1.46–2.25) and 2.97 (95% CI 1.67–5.17) times greater odds of reporting any housing instability and homelessness, respectively, than non-RSOs. Findings represent some of the strongest evidence to date for the high risk of housing instability and homelessness among RSOs, suggesting a clear gap in policy and programmatic responses to their unique housing needs. Evidence-based alternative approaches to residence restriction laws may reduce recidivism and protect public safety.
Evaluation of a Resiliency Focused Health Coaching Intervention for Middle School Students: Building Resilience for Healthy Kids Program
Authors: Lee Joey A. , Heberlein Erin , Pyle Emily , Caughlan Thomas , Rahaman Darvi , Sabin Margaret , Kaar Jill L.
Published: September 2020

Introduction:

Youth mental health issues are a growing public health concern. Resilience has been identified as a mitigating factor for adverse mental health outcomes. Schools have shown an increasing interest in strategies to support students’ mental health. The purpose of this study was to evaluate a school-based 1:1 health coaching program designed to build resilience by teaching students coping skills and strategies to increase their self-efficacy.

Study Design:

Single group intervention study with pre/post measures.

Setting/Participants:

Sixth grade students (aged 11-12 years) attending an urban middle school.

Intervention:

Youth participated in up to 6 resiliency-focused, 1:1 health coaching sessions completed over 8 weeks and conducted during the school day. Health coaches utilized motivational interviewing techniques to set and work toward resilience-related goals focused on improving coping skills and self-efficacy with youth during the intervention (January through March 2020).

Main Outcome Measures:

The Child and Youth Resilience Measure-Revised and other mental health assessments were completed at baseline and immediately following completion of the intervention to evaluate outcomes. Paired sample t-tests and Hedges’ g effect sizes were conducted to evaluate intervention effectiveness. Student participation rates were assessed throughout the intervention.

Results:

287 youth participated in the study (87% participation rate) and participated in over 85% of health coaching sessions offered. A paired samples t-test revealed the youth resilience significantly increased from pre ( M = 75.7, SD = 6.9) to post ( M = 77.6, SD = 6.8) intervention ( t[257] = 3.73, p < .001) and the size of the effect was medium ( g = 0.29, 95% CI = 0.11, 0.46).

Conclusions:

The findings demonstrate that health coaching can be an effective strategy for improving resiliency in youth. Future studies evaluating how to effectively disseminate this intervention strategy are planned.
Examining the Career Self-Management Model Among Native American Students With STEM Career Goals
Authors: Turner Sherri L. , Lee Hangshim , Jackson Aaron P. , Smith Steve , Mason-Chagil Gale , Jacobs Sue C.
Published: September 2020

Native Americans are highly underrepresented in science, technology, engineering, and math (STEM) careers; however, little research exists concerning how to promote Native Americans’ participation in STEM. In this study, we address this gap by examining variables hypothesized to promote participation using the career self-management (CSM) model among Native American college students with STEM career goals. Results of stepwise regressions demonstrated that academic achievement along with the problem-solving aspects of career self-management (CSM) self-efficacy and instrumental assistance from parents, peers, and others in students’ schools and communities predicts clearer, more specific, and more personally congruent goals; and that these goals along with self-efficacy and instrumental assistance predict career exploration. Contrary to hypotheses, neither STEM outcome expectations nor gender was related to goals or exploration. These findings suggest that CSM can be used to guide research regarding the STEM career development of Native American college students.
Patterns of Psychoactive Medication Use in Community-Dwelling Older Adults in the US in 2016: A Descriptive Cross-Sectional Study
Authors: Bajracharya Rashmita , Qato Danya M.
Published: September 2020

Objectives: We aim to quantify any use and long-term use patterns of psychoactive medications and explore differences in use by sociodemographic factors in older adults (60–85 years) using the 2016 Medical Expenditure Panel Survey. Methods: Prevalence estimates of any use and long-term use were calculated. Chi-square and crude odds ratios were calculated to estimate differences in any use and long-term use of psychoactive medication by sociodemographic characteristics of respondents. Results: Thirty percent of older adults in the US reported any use of psychoactive medications. Long-term use was significantly higher in women (28.3% [95% confidence interval: 26.5, 30.2]), white (27.8 [26.1, 29.7]), presently unmarried (27.5 [25.4, 29.7]), and low-income (30.3 [27.7, 32.9]) subgroups than in men (20.5 [18.4, 22.5]), Black (14.7 [12.3, 17.1]), presently married (22.8 [20.7, 24.9]), and high-income (21.1 [19.1, 23.1]) subgroups, respectively. Discussion: Despite continued risks associated with use, long-term use of psychoactive medications is prevalent in the older adult population in the US. Given the increased complexity of pharmacotherapy regimens in this population, enhanced efforts at improving use of psychoactive medications should be intensified.
Analysis of chest injury characteristics in frontal vehicle collision under three typical overlaps
Authors: Shi Xuewei , Xiao Sen , Qie Yanchao
Published: September 2020

In view of the relatively serious situation of chest injuries in current vehicle accidents, this study aims to determine the chest injuries characteristics in frontal vehicle collisions under different overlaps. The frontal impact simulation was first established and conducted based on the latest THOR dummy model with different overlaps. By comparing chest dynamic output indicators under three different overlap rates in frontal impact conditions, the relationship between chest injuries and collision overlap rates was analyzed in terms of the chest deflection and stress/strain distribution. Results show that changes of the thoracic stress/strain distribution and the amplitude of chest deflection are more sensitive to frontal impact load under a great impact overlap. In the kinematics analysis, there is a significant twist along the seatbelt route to the occupant’s chest. The changes of the chest deflection and stress/strain based on the design parameter changes at different overlap rates are consistent, and the highest injury risk is captured in the ribcage structure of mid-chest in full frontal impact. The research results can provide a reference for the optimal design of the constraint system for the future.
Robust two-degree of freedom H∞ control design for a twin rotor multi-input multi-output system with external disturbances and model uncertainties
Authors: Jagadeb Smruti Ranjan , Subudhi Bidyadhar , Naskar Asim Kumar
Published: September 2020

The control of twin rotor multi-input multi-output system is difficult as it is subjected to model uncertainties and external disturbances. Furthermore, there also exists a coupling between pitch and yaw positions, which makes the system more difficult to control them separately. Considering the above difficulties in twin rotor multi-input multi-output system control, [Formula: see text] robust controller is designed to handle the model uncertainties and external disturbances with two-degree-of-freedom. A mixed sensitivity approach is employed to represent the uncertainties and external disturbances arise in the twin rotor multi-input multi-output system. For performance analysis, first the proposed two-degree-of-freedom [Formula: see text] controller is compared with the ‘Linear Quadratic Regulator-Linear Matrix Inequality’–based robust proportional–integral–derivative controller and Internal Model Control–based proportional–integral–derivative controller in MATLAB/Simulation and then in experimentation. From the obtained results, it is confirmed that the proposed controller exhibits enhanced robustness, faster tracking performance and accurate disturbance attenuation, when compared with Linear Quadratic Regulator-Linear Matrix Inequality–based robust proportional–integral–derivative controller and Internal Model Control–based proportional–integral–derivative controller in face of external disturbances and uncertainties.
MiR-32-5p knockdown inhibits epithelial to mesenchymal transition and renal fibrosis by targeting SMAD7 in diabetic nephropathy
Authors: Wang H-J , Liu H , Lin Y-H , Zhang S-J
Published: September 2020

Diabetic nephropathy (DN) is primary cause of end-stage renal disease. A previous study has shown that miR-32-5p (miR-32) is highly expressed in kidney tissue during chronic allograft dysfunction with interstitial fibrosis and tubular atrophy. However, the role of miR-32-5p (miR-32) in DN is still unclear. In this study, streptozotocin-induced DN rat models and high glucose (HG)-incubated human kidney proximal tubular epithelial (HK-2) cells were established to investigate the role and underlying mechanisms of miR-32 in DN. Results of real-time PCR revealed that miR-32 levels were greatly increased in DN rats and HG-incubated HK-2 cells. Downregulation of miR-32 effectively relieved HG-induced autophagy suppression, fibrosis, epithelial-mesenchymal transition (EMT) and inflammation in HK-2 cells. Besides, miR-32 overexpression significantly down-regulated the expression of mothers against decapentaplegic homolog 7 (SMAD7), whereas knockdown of miR-32 markedly up-regulated the level of SMAD7. Dual-luciferase reporter gene assay confirmed that SMAD7 was a target of miR-32. Reintroduction of SMAD7 expression rescued miR-32-induced HK-2 cells autophagy suppression, EMT and renal fibrosis. Our findings indicate that miR-32 may play roles in the progression of EMT and fibrosis in DN.
Biologics targeting type I interferons in SLE: A meta-analysis and systematic review of randomised controlled trials
Authors: Koh Jeffery Wei Heng , Ng Cheng Han , Tay Sen Hee
Published: September 2020

Objective

The feed-forward loop of type I interferons (IFNs) production and subsequent immunopathology of systemic lupus erythematosus (SLE) has been hypothesised to be disrupted with inhibition of IFNα or type I IFN receptor subunit 1 (IFNAR). This systematic review and meta-analysis present the treatment efficacy and safety profile of monoclonal antibodies inhibiting IFNα or IFNAR.

Methods

A search was done using Medline, Embase and ClinicalTrials.gov for biologics targeting IFNα or IFNAR in SLE up to 3 Jan 2020. For the meta-analysis, analyses of binary variables were pooled using odds ratio (OR) with the Mantel Haenszel model.

Results

Anifrolumab 300 mg (n = 3 studies, 927 patients) was more effective than placebo in achieving SRI(4) (pooled OR = 1.91, CI 1.11-3.28, P = 0.02) and BICLA response (pooled OR = 2.25, CI 1.72-2.95, P < 0.00001). In SLE patients with high type I IFN gene signature, SRI(4) response was not achieved with anifrolumab in 2 studies, 450 patients. Treatment with IFNα and IFNAR inhibitors (n = 7 studies, 1590 patients) increased the risk of herpes zoster infection (pooled OR = 3.72, CI 1.88–7.39, P = 0.0002), upper respiratory tract infections, nasopharyngitis and bronchitis.

Conclusion

This meta-analysis substantiates IFNAR as a therapeutic target in SLE. Inhibition of type I IFNs predisposes to herpes zoster and other viral infections.
Differences in practice and preferences associated with truth-telling to cancer patients
Authors: Wu Jing , Wang Yan , Jiao Xiaodong , Wang Jingting , Ye Xuchun , Wang Bei
Published: September 2020

Background:

Doctors should disclose the diagnosis to patients according to the principle of autonomy. However, not disclosing the diagnosis and prognosis to cancer patients remains common in mainland China.

Objective:

The study explored the experiences and attitudes of patients with cancer, family members, and the medical staff in truth-telling.

Research design:

A quantitative survey with three closed-ended questionnaires was conducted.

Participants:

In all, 137 patients with cancer, 134 family members caring for cancer cases, and 54 medical staff were surveyed. Descriptive statistics were used to summarize all characteristics, and the chi-square test was performed to analyze group differences in attitudes toward cancer disclosure.

Ethical considerations:

This study was approved by the Committee on Ethics of Biomedicine Research, at the Second Military Medical University (HJEC-2018-YF-001). Informed consent was obtained from all participants prior to study commencement.

Findings:

A total of 59.8% of patients were informed about their diagnosis within 1 week, and 19.7% inferred theirs. The medical staff preferred to prioritize family members in informing about patient diagnosis while 77.4% of patients preferred to be told the whole truth at the time of initial diagnosis. More patients than family members and medical staff wanted the patients to be informed about the diagnosis ( p < 0.001). A significant difference was found between the patients and family members regarding who should tell the patients.

Discussion:

The willingness of patients in knowing the truth was underestimated by their family members as well as the medical staff. Guessing the truth indirectly may exert negative effects on the patients, and not telling the truth is inappropriate in patients who want to be informed.

Conclusion:

Disclosure of a cancer diagnosis is a complex process involving medical practice, as well as a range of cultural, ethical, and legal factors. The medical staff should first assess each patient’s willingness in truth-telling and inform about disease diagnosis with respect. Emotional support and comfort from family members are encouraged. Anyone in the patient’s care team, especially nurses, could be integrated in the process of truth-telling.
Class action certification and constitutional claims: The South African case
Authors: Broodryk Theo
Published: September 2020

This article considers whether, in the case of South African, there is a valid basis for requiring certification of certain types of class actions only. Specifically, the article will consider whether a preliminary certification requirement should apply to constitutional claims against the government in the same way it applies to other class actions. To determine this issue, the purpose of certification is considered with a view to establishing whether said purpose is only given effect to in certain circumstances. If certification would serve no purpose in the context of Bill of Rights claims or claims which display a public character, it may be prudent not to require class action certification in such cases. Conversely, if certification would still serve a purpose in those types of cases, it should remain part of class proceedings. To assist in making this determination, the position in several European jurisdictions, Ontario and the United States is considered.
‘This looks like a job for an accountant! (with good funeral insurance)’: The changing roles of accountants in superhero comics from 1938 to 2018
Authors: Rocher Sébastien , Christensen Mark , Roy Yves
Published: September 2020

The roles of accountant characters in a coherent genre of entertainment media, and over time, remain surprisingly under-researched. In this study, it is argued that the roles of accountants in society can be interpreted from longitudinal analyses of the roles played by accountant characters in entertainment media narratives depicting fictional worlds. Analysis is provided of narratives in which actantial and thematic roles are played by accountants in 178 US superhero comics’ narrative sequences between 1938 and 2018. The sequences were those in which at least one character is presented as an accountant. The study reveals that accountants have increasingly been portrayed in more positive than negative roles since the beginning of the twenty-first century and have become symbolic superheroes. At the same time, this study also shows that individual accountants do not last long in these narratives, even though they have a positive role. This article shows how one genre of entertainment media has conveyed an improved image of accountants in fictional worlds, to give them progressively a place of importance comparable perhaps to the one that their professional bodies argue they occupy in modern society. Even if some negativity is still attached to the accountant, their image is progressively changing for a better one based on the roles they played because they are accountants.
The cancer care observation: an empathy training experience
Authors: Dwyer Justin , O’Callaghan Clare , Ross Margaret
Published: September 2020

Objective:

A ‘cancer care observation’ (CCO) empathy training is described. This study examined psychiatry trainees’ experience of CCO and cancer patients’ experience of being observed.

Method:

Trainees were paired with consenting patients undergoing cancer treatment; they observed a number of cancer treatment sessions and chronicled their experiences. The observations were discussed in supervision. Semi-structured interviews were conducted with trainees and observed patients. Observation journals and transcribed interviews were analysed using qualitative description.

Results:

Seven trainees participated. Three themes emerged: patients used trainees to support themselves while trainees struggled with role identities; CCO extends trainees’ professional awareness and can benefit patients; and staff reactions were mixed. Trainees developed wide-ranging, empathic insights into cancer and hospital care experiences. No patient regarded CCO as intrusive.

Conclusions:

Trainees garnered insights from CCO as they generated clinical hypotheses, learnt about professional boundaries and gained first-hand experience of unconscious mental processes based on their empathic connections. CCO lends itself to psychiatry and, potentially, other medical trainees.
“Little more than a gut feeling?”—considerations when prescribing psychotropic medications to patients undergoing bariatric surgery
Authors: Braun Anastasia , Bruxner George
Published: September 2020

Objective:

Bariatric surgical procedures are being commonly performed increasingly, and many surgical candidates are concomitantly taking psychotropic medication. This paper aims to elucidate issues when prescribing psychiatric medication in this setting of substantial anatomical and physiological change.

Method:

A hand search of the literature to assess the current understanding of effects of various bariatric procedures on the bioavailability of psychotropic medication.

Results:

Predominantly malabsorptive bariatric procedures may reduce bioavailability of some but not all commonly used psychiatric medications. There is minimal information about the effects of the most commonly performed surgery, vertical sleeve gastrectomy. Lithium prescription and monitoring requires caution.

Conclusions:

There is limited guidance for prescription for psychotropic medication in the bariatric surgery patient group, and vigilance for unexpected adverse effects or altered efficacy is warranted.
l’Optimisme and youth mental health: has it attained Voltaire’s ‘best of all possible worlds’?
Authors: Allison Stephen , Bastiampillai Tarun , Looi Jeffrey CL
Published: September 2020

Objective:

Youth mental health has been politicised by high-profile health advocates, and often leads the Australian national policy agenda. The ensuing debate is being conducted at multiple levels: scientific, clinical, economic and political. These levels interact, and we explore how scholars’ experiences with early intervention (EI) shape their roles as health advocates and political lobbyists.

Conclusions:

Health advocacy influences major government decisions. EI researchers have been successful as health advocates in Australia, attracting substantial government funding for selected youth mental health programmes. Positive experiences with the short-term gains of EI might encourage the necessary optimism amongst researchers for successful health advocacy. However, as medical experts, clinicians are aware that most patients and carers face a huge burden from schizophrenia, even after high-quality EI. These patients require fully integrated and well-funded mental healthcare across the lifespan.