bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-19 Mortality Disparities Among Socially Vulnerable Medicare Beneficiaries Associated With the Quality of Nurse Work Environments in U.S. Hospitals
Authors: Brooks Carthon J. Margo , Muir K. Jane , Iroegbu Christin , Langston Christine , Amenyedor Kelvin , Nikpour Jacqueline , Lasater Karen B. , Mchugh Matthew D. , Kutney-Lee Ann
Published: September 2024

COVID-19 mortality disparities for socially vulnerable patients, including individuals facing higher levels of poverty, housing insecurity, and limited transportation, have been linked to the quality of hospitals where they received care. Few studies have examined the specific aspects of hospitals, such as nursing care quality, that may underlie disparate outcomes. Recent studies suggest that nursing resources in the pre-pandemic period were associated with mortality during the COVID-19 public health emergency. In this study, we examined the association between social vulnerability, the nurse work environment, and inpatient mortality among Medicare beneficiaries hospitalized with COVID-19. A cross-sectional analysis was conducted of linked survey data collected from nurses working in New York and Illinois, Medicare claims, American Hospital Association Annual Survey data, and the Social Vulnerability Index (SVI). Higher mortality rates were observed among patients in the highest quartile of social vulnerability compared to the lowest (6870 [25.8%] vs 5019 [19.1%]; P < .001). Using multivariable regression modeling, a statistically significant interaction was found between the highest SVI quartile and the nurse work environment (OR, 0.86; 95% CI, 0.76-0.98; P < .05), implying that the effect of a higher quality nurse work environment on mortality was decidedly greater for patients in the highest quartile (odds ratio = 0.86 × 0.94 = 0.80) compared to patients in the lowest quartile (OR, 0.94). Post-hoc analyses demonstrated that hundreds of COVID-19 related deaths among the most socially vulnerable patients may have been avoided if all hospitals had a high-quality nurse work environment. Strengthening the quality of nurse work environments may help to reduce health disparities and should be considered in public health emergency planning, specifically in hospitals serving socially vulnerable communities.
Bullying victimization and psychological adjustment in Chinese students: The mediating role of teacher–student relationships
Authors: Lin Shanyan , Longobardi Claudio , Mastrokoukou Sofia , Fabris Matteo Angelo
Published: September 2024

The association between the quality of teacher–student relationships and children's psychological adjustment has been mainly studied in Western countries; however, this research topic is gaining more interest in Eastern countries. Based on attachment theory and empirical evidence, this cross-sectional study examined the relationship between bullying victimization and psychological adjustment (internalizing and externalizing symptoms) as well as the mediating role of the teacher–student relationship (closeness and conflict) in this association. Nine hundred seventy-four Chinese students aged 11 to 16 years ( Mage = 12.56, SD = 1.24) participated in this study and completed corresponding questionnaires. The results indicated that bullying victimization was directly and positively associated with internalizing and externalizing symptoms and that closeness and conflict in student–teacher relationships played mediating roles in this associations. Results, limitations, and practical implications are discussed.
Simulating lobbying: A problem based learning approach to teaching interest groups
Authors: Coen David , Katsaitis Alexander
Published: September 2024

Programmes teaching public policy and administration (PPA) increasingly include dedicated modules or courses on interest groups (aka public affairs, aka government affairs aka lobbying). Despite its journalistic familiarity, the topic of lobbying includes concepts that may appear particularly abstract to students. Given the shift towards problem-based learning (PBL) approaches in PPA programmes, courses could benefit from such activities on this specific topic. Complementing other pedagogical methods, we developed a PBL activity that allows students to practically apply their newly gained knowledge on the subject through a simulation game. We found that the game was popular amongst students and helpful as a learning tool. Students left the activity feeling they can better contextualize theory and concepts. Aiming to broaden the use of such pedagogical tools in teaching government affairs, this paper provides an outline behind the games' context, its main steps, some reflections on its effectiveness, and a case example with relevant links in the annex to implement and/or adapt to different settings.
Oropharyngeal Lipoma: A Rare Case of Dysphagia
Authors: Yousfi Ghada , Gharss Oumaima , Sghaier Yasmine , Sellami Nesrine , Kharrat Rania , Boudawara Tahia , Hammemi Boutheina , Chareffedine Ilhem
Published: September 2024

Lipomas are benign and slow-growing neoplasms that typically develop in the subcutaneous tissue. They rarely occur in the upper aerodigestive tract. Oropharyngeal lipomas are rare. They represent 0.5% of all neoplasms of the head and neck. We present a case of a 43-year-old female with a polypoid mass in the base of the left palatine tonsil. The patient underwent a left tonsillectomy and a resection of the mass. The pathological diagnosis was tonsillar lipoma. We describe the clinical characteristics and the management of this rare case. Palatine tonsillar lipoma is a rare benign tumor with an unusual recurrence rate, and an excellent prognosis.
Conspiracy Beliefs and the Perception of Intergroup Inequalities
Authors: Nera Kenzo , Douglas Karen M. , Bertin Paul , Delouvée Sylvain , Klein Olivier
Published: September 2024

Conspiracy beliefs are prevalent among members of disadvantaged groups. Adopting a social identity perspective, we hypothesized that these beliefs would reduce the endorsement of internal attributions for inequalities that could negatively affect the image of disadvantaged ingroups. In Study 1 ( n = 1,104), conspiracy mentality was negatively associated with meritocracy beliefs, which attribute success and failure to internal factors. In Studies 2 to 5 ( ns = 179, 251, 221, 248), taking the perspective of a person exhibiting a high (vs. low) conspiracy mentality in a fictitious context reduced participants’ meritocracy beliefs, internal attributions for a privileged outgroup’s situation, and fostered negative attitudes toward the outgroup. However, it did not reduce internal attributions for the situation of a disadvantaged ingroup, nor did it improve attitudes toward the ingroup. Regarding intergroup comparison, conspiracy mentality seems to primarily deteriorate the perception of privileged outgroups rather than improve the perception of disadvantaged ingroups.
Global communication as a standpoint: A critical engagement with research, pedagogy, and the profession through a global communication lens
Authors: Girginova Katerina , Han Woori , Jaber Heather , Kim Jinsook , Madenga Florence , Morales-Suárez Mariela , Celeste Wagner María , Wang Jing
Published: September 2024

Grounded in the long tradition of embracing the global in communication and media studies and inspired by feminist standpoint epistemology, we argue that global communication can function as an epistemological standpoint. After summarizing the diverse and rich tradition of understanding the global in communication and media studies and beyond, we theorize that a global communication standpoint is characterized by a combination of four aspects that can be embraced across the discipline: contextualization, historical rootedness, attention to power, and engagement with issues of relationality and comparison. First, we offer examples of the four elements based on existing scholarship. Second, we analyze how these four elements can be embraced in pedagogy. Finally, we survey recent job market dynamics to analyze the definition of the global by professional practice. We conclude by arguing that the embracement of global communication as a standpoint can benefit research across our discipline, regardless of research questions, methods, contexts, or scholars’ identities.
Fostering resilience: Community radio and disaster communication in Odisha, India
Authors: Kanjilal Manas Kumar , Malik Kanchan K , Kapoor Priya
Published: September 2024

Local voices carry tremendous weight during natural disasters, yet the possibilities for employing participatory communicative practices for disaster management in India have not been fully explored. Effective community-centred disaster communication garners participation in disaster management processes that reduce vulnerabilities. This paper examines how various community-based organisations used community radio to enhance community engagement and the effectiveness of the disaster management processes in the eastern Indian state of Odisha. The research relies upon case studies of disaster communication practices of two community radio stations during the ‘very severe cyclonic storm’ Yaas, which made landfall in Odisha. It describes the conceptual shift in the disaster risk reduction approach towards community participation and the role of information and communication in disaster management. It then discusses the historical trajectories of disasters and vulnerabilities in Odisha. The following sections analyse how the social relationships facilitated by community radios augment the effectiveness of the disaster communication process. The paper explains how two community radio stations engaged with the communities to promote early warning, preparedness, response and revitalising measures during Cyclone Yaas. It argues for prioritising community radio as a component in all disaster communication endeavours as a means to strengthen community capacities and enhance community resilience.
Poetry and democratic education
Authors: Tampio Nicholas
Published: September 2024

Should public schools provide students with opportunities to write poetry? If so, why? The modern education reform movement insists that students be able to answer questions citing specific textual evidence. In practice, this means that American public education focuses on standardized testing and gives students few opportunities to say something new. In this essay, I explain how Charles Taylor’s expressivist thesis justifies a place for poetry in the public-school curriculum. According to Taylor, the designative-instrumentalist theory of language emphasizes its role in transmitting pre-existing thoughts. The constitutive-expressivist theory of language, on the contrary, maintains that people form and clarify their thoughts in expressing them. For the latter view, poetry is a way to give voice to one’s authentic self, one’s community, and the cosmos. This article brings this insight into contemporary debates about the curriculum and explains the democratic value of encouraging students to express themselves.
Magnitude, Extent, and Burden of Substance-use Disorders in West Bengal: Findings from the National Mental Health Survey (NMHS), 2016
Authors: Basu Aniruddha , Jayashankar Pavithra , Guin Aparajita , Sarkar Sukanto , Saha Pradip Kumar , Misra Raghunath , Sinha Debasish , Neogi Rajarshi , Saha Soumyadeep , Benegal Vivek , Rao Girish N , Varghese Mathew , Gururaj Gopalkrishna
Published: September 2024

Introduction:

Substance-use disorders (SUDs) are a public health problem. The Global Adult Tobacco Survey (GATS) and National Family Health Survey (NFHS) provide evidence of high usage. Hence, the National Mental Health Survey (NMHS) WB data were analyzed to estimate the prevalence, pattern, disability burden, and service utilization of SUD.

Methodology:

The usual NMHS methodology was used. Four districts were selected, and thereafter, a multistage random sampling was done. The validated Bengali version of the Mini International Neuropsychiatric Interview (MINI) and other instruments like the Fagerstrom Test for Nicotine Dependence (FTND), disability, and health care utilization modules were used.

Results:

A total of 2,646 eligible members (age >18 years as per 2011 census) were interviewed. It was found that alcohol use as per MINI at least 3 drinks of alcohol within 3 hours on 3 or more occasions was 3.9%, and the weighted prevalence of alcohol-use disorder (AUD) and tobacco-use disorder (TUD) was 3.04% and 14%, respectively. The AUD and TUD prevalence was lower than the national prevalence, yet they were more prevalent in urban areas than in the national trend. The ratio of women to men suffering from AUD in WB (1:5) was one of the highest in the country (all India average 1:18). Also, the treatment gap of 89.2% was more than the national average.

Discussion:

SUDs are an important public health problem in the state of WB, which requires further research, particularly among women, comorbid psychiatric disorders, and in urban areas.
Rethinking “musical excellence” from a decolonial perspective: Disruptive autobiographical experiences among doctoral scholars
Authors: Liu Lu , Garcia-Cuesta Sergio , Chambers Laura , Tchirkov Sergej , Hebert David G.
Published: September 2024

This collaborative autoethnography was developed by recent doctoral students in music from Southern Europe, Eurasia, East Asia, and North America, along with a professor based in Northern Europe. Our primary research question is “What can disruptive autobiographical experiences teach us about the implications of the decolonization movement for redefining “musical excellence” in higher music education?” The co-authors interviewed each other for their respective personal narratives on this theme, then collaboratively coded, analyzed and developed their results and interpretations. Four sub-questions served as prompts: (1) What was your gateway into music and how did the music learning-tradition that you were exposed to affect your development as a musician? (2) In what ways was the concept of “musical excellence” a part of your (early) development as a musician? (3) How does the concept of “musical excellence” impact how being an “artist” is defined by you and people around you? (4) How did this perception of “what is an artist” affect your musical path (and even how others perceive your career)? We share our findings and discuss implications in terms of possible innovations to higher music education, definitions of “musical excellence,” approaches to evaluation, and the role of competition in education.
A quantitative study on the professional competency enhancement of persons with visual impairment in Tamil Nadu
Authors: Basu Madhurenu , Rani K Sambath
Published: September 2024

Independent living is one of the fundamental human rights of persons with visual impairments and employment plays a pivotal role in improving the quality of life. However, the employment rate of persons with visual impairment is comparatively insubstantial in the current scenario. It can be addressed through a structured training programme which may benefit persons with visual impairments by enhancing their professional competencies. The study aimed to provide QR-code-assisted instructions to enhance the essential skills required for showcasing professionalism. A purposive sampling method was used to select the participants ( N = 60), from the Coimbatore District, Tamil Nadu, and pre- and post-test data were collected through face-to-face interview schedules consisting of four domains: (a) workplace behaviour, (b) workplace culture, (c) soft skills, and (d) maintaining personality. QR-code-assisted instructions were provided individually, and the one-way analysis of variance (ANOVA) test results ( p < .01) indicated that QR-code-assisted instructions effectively enhanced professional behaviour skills among persons with visual impairments. Employment can be considered a measure of success applied equally to everyone. The authors designed and developed a training package, provided training to the participants using it, and the outcomes are discussed concerning the type of visual impairments and gender of the participants.
Reliability and validity of Urdu version of Tromso Social Intelligence Scale for visually impaired adolescents
Authors: Noor Hina , Majid Shaista , Mahmud Shamaila , Shaheen Saima
Published: September 2024

In Pakistan, there is a lack of linguistically validated methods for measuring social intelligence quotient (IQ), particularly for those with visual impairment. This study sought to determine the validity and reliability of the Urdu version of the Tromso Social Intelligence Scale (TSIS) for visually challenged teenagers. A total of 215 visually impaired (VI) adolescents (108 male, 107 female) studying in government schools for blind in Rawalpindi division participated in the study. The study was conducted in two phases: translation and validation of the scale. In the first stage, forward and backward Urdu translation by the researcher with the help of five bilingual (English and Urdu) language experts was carried out. Content and face validity were carried out through experts in second stage. Finally, after changing the items according to the suggestions and recommendation of experts, the final questionnaire was administered for the pilot testing on 10 VI adolescents. The final questionnaire consisting of 21 items on scale 1 ( describes me extremely poorly) to 7 ( describes me extremely well) was administered on main sample of the study. Findings showed that the coefficient of alpha reliability for the TSIS was .93. Further test–retest, split-half, and inter-rater reliability were also proved to be appropriate and acceptable, making the Urdu version of the Tromso Social IQ Test a reliable tool to use in Pakistan. A four-component structure was discovered using factor analysis for VI youths in Pakistan. The study established that the factor structure of TSIS is different in Pakistani context as compared to the three factors, original scale developed in the western cultural context. For social and psychological integration, it is necessary to explore VI adolescents’ social intelligence with linguistically appropriate tool.
Friends Can Help to Aim High: Peer Influence and Selection Effects on Academic Ambitions and Achievement
Authors: Vit Eszter , Bianchi Federico , Castellani Marco , Takács Károly
Published: September 2024

During early adolescence, the influence of friends becomes more pronounced. This study models the effect of friends’ academic ambitions on adolescents’ ambitions while controlling for friends’ academic achievement and disentangling social influence from friendship selection using random coefficient multilevel stochastic actor-oriented models (SAOM) on a longitudinal sample of 19 school classes ( N = 407) in grades six through eight. The findings indicate that adolescents adjust their academic ambitions to align with their friends’ ambitions and their achievement to match their friends’ achievement. However, their ambitions are unaffected by their friends’ achievement, and vice versa. These results highlight friends’ influence while demonstrating that complex social influence across these outcomes is not evident despite the interdependence of academic ambitions and achievement within individuals. Moreover, the mechanisms of social influence vary across subjects. In Hungarian literature, friends’ high ambitions and achievement drive similarity, whereas in mathematics, the opposite pattern underscores the domain-specific nature of ambitions.
A rare case report of Prevotella lung abscess diagnosed using third-generation metagenomic sequencing
Authors: Wu Xiaorui , Qi Tianqi , Zhang Mingding , Bi Junfang
Published: September 2024

The Prevotella genus consists of obligate anaerobic Gram-negative bacteria that are symbiotic with the oral, intestinal, and vaginal mucosa. While several species of Prevotella have been implicated in pulmonary infections, identification of Prevotella as the causative agent of lung abscess is uncommon because of the requirement for stringent anaerobic culture conditions. In this report, we highlight a case of lung abscess caused by Prevotella salivae and Prevotella veroralis, underscoring the importance of third-generation metagenomic sequencing using devices from Oxford Nanopore Technologies for the precise diagnosis of specific pathogens.
Case report: a case of single-sided shoulder blade fracture resulting from an electrical shock
Authors: Chen Hai-rui , Ren Yong-dong , Hu Nian-dan , Wang Rui , Li Wen-qiang
Published: September 2024

Electric shock injuries, a category of severe industrial accidents, often entail the risk of multi-organ damage. In the present unique case report, the infrequent occurrence of a right scapular fracture stemming from an electric shock accident is described. A male patient in his early 30s accidentally received an electric shock while working, resulting in pain in the right upper limb and shoulder. Although he had no obvious external injuries, physical examination revealed a decrease in muscle strength in the right upper limb. Following magnetic resonance imaging and computed tomography, a comminuted fracture of the scapula was diagnosed. The patient received emergency symptomatic treatment, including pain relief, anti-infection measures, and nutritional support for the myocardium, and subsequent orthopaedic surgical intervention for fracture fixation. The patient recovered well after surgery, with muscle strength gradually returning. This report documents the rarely-described occurrence of non-traumatic unilateral scapular fractures following an electric shock. Medical practitioners should be aware of the wide range of potential injuries, including fractures, when evaluating patients with electric shock injuries.
From Wellens’ syndrome to acute anterior myocardial infarction, what is required? Only time!
Authors: Zhang Xu , Kou Yafen
Published: September 2024

The hallmark of Wellens' syndrome is a distinct modification in the precordial T wave of the electrocardiogram (ECG), which usually indicates substantial stenosis of the proximal left anterior descending artery (LAD). Patients with Wellens' syndrome commonly do not exhibit any symptoms of chest pain. This current case report describes a male patient in his early 60s who presented with sporadic chest pain who was subsequently diagnosed with Wellens’ syndrome-related electrocardiographic abnormalities. In the precordial leads V2–V5, an inverted symmetric T wave was visible on the asymptomatic ECG. The inverted symmetric T wave of the precordial lead V2–V5 reverted back to being upright when the chest pain started. A follow-up ECG performed before emergency surgery revealed ventricular premature beats and an increase of 0.1–0.5 mV in the ST segment of the precordial leads V1–V5. A drug-eluting stent was inserted after the patient's coronary angiography revealed proximal stenosis of the LAD. To prevent acute myocardial infarction, emergency physicians must identify the ECG signs of Wellens’ syndrome and treat high-risk patients with revascularization as soon as feasible. Early recognition and proactive intervention are crucial, as they may help to alleviate adverse consequences.
Relegitimising the voluntary carbon market: Visions of digital monitoring, reporting and verification
Authors: Christiansen Kirstine Lund
Published: September 2024

The voluntary carbon market (VCM) faces a legitimacy crisis amid accusations of greenwashing, just as companies worldwide increasingly rely on it to achieve their net-zero targets. To address the criticisms, digital technologies to improve the monitoring, reporting and verification (MRV) process of nature-based carbon projects are envisioned to provide greater transparency and thus restore the legitimacy of the market. This study analyses narratives and visions developing around digital MRV, building on observations at industry events and public communication from digital MRV enterprises. Drawing on critical nature-society scholarship and literatures on green capitalism, I argue that digital MRV enables a vision of planetary improvement through large-scale nature restoration. Yet, as the technologies are largely used to produce a larger supply of more trust-worthy carbon credits, I suggest that digital MRV mainly serves to solve two issues in the VCM, namely that of buyers facing reputational risks and expected supply constraints. As such, I argue that digital MRV by providing non-disruptive disruption through making nature legible to market logics serves as a technical fix to the VCM’s legitimacy crisis. Rather than transforming carbon markets and nature restoration, digital technologies enable and relegitimise ongoing carbon offsetting practices and in turn capital accumulation by incumbent stakeholders.
Introduction: Explanation, critique and critics of geoeconomics
Authors: Mallin Felix , Sidaway James D , Cheng Han , Woon Chih Yuan
Published: September 2024

Geoeconomics, strategist Edward Luttwak affirmed in 1990, represented the waning of a geopolitical era and the ascent of a ‘logic of conflict with the methods of commerce’. In the decades since, numerous variations on his argument have enjoyed wide resonance. Geoeconomics became a term of reference for power contests from the realms of commercial warfare and infrastructure expansionism to the sculpting of new military and economic blocs. Nonetheless, ahistorical references to geoeconomics have proliferated at the expense of critical attention to past conjunctures when geoeconomics circulated. As a result, the ideological framings and impacts of the discourse of geoeconomics and its wider relationship to geopolitics have been neglected. In this introduction, we set the backdrop to and provide a brief overview of the essays that follow. Collectively and from different vantage points, these essays discuss the analytical purchase and some limitations of advancing ‘critical geoeconomics’. Contributions combine timely reassessments of contemporary and past iterations of geoeconomics and explore the potential for positing an anti-geoeconomics in light of resurrected nationalist-imperialist phantoms.
Outcomes After Osteochondral Allograft Transplantation of the Medial Femoral Condyle in Patients With Varus and Nonvarus Alignment
Authors: Wang Tim , Gao Sean L. , McCauley Julie C. , Densley Sebastian M. , Bugbee William D.
Published: September 2024

Background:

Fresh osteochondral allograft (OCA) transplantation is an effective technique for the treatment of focal chondral and osteochondral defects in the knee. Coronal-plane malalignment leads to increased contact forces within a compartment and subsequently the cartilage repair site and may lead to higher failure rates. However, the magnitude of the effect of coronal-plane malalignment on graft survivorship and clinical outcomes has not been well characterized.

Purpose:

To evaluate how varus malalignment affects graft survival and patient-reported outcomes after isolated OCA transplantation of the medial femoral condyle (MFC).

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 70 patients (74 knees) who underwent primary OCA transplantation of the MFC between 2005 and 2019 were identified from a prospectively collected single-surgeon cartilage registry with a minimum 2-year follow-up. Coronal-plane alignment was evaluated utilizing standing hip-to-ankle radiographs. OCA failure, defined as removal of the graft or conversion to arthroplasty, and reoperations were recorded. Patient-reported outcomes were obtained preoperatively and postoperatively using the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, modified Merle d’Aubigné–Postel score, and overall patient satisfaction score.

Results:

The mean mechanical tibiofemoral angle for patients with varus alignment was 3.9° of varus (range, 1.1° to 8.9°) and for patients with nonvarus alignment it was 0.02° of valgus (range, 3.6° varus to 4.6° valgus). Graft survivorship was 95.3% in the varus group and 95.8% in the nonvarus group ( P = .918) at 5 years postoperatively. Reoperations after OCA transplantation occurred in 14.0% of the varus group and 22.6% of the nonvarus group ( P = .336). The mean International Knee Documentation Committee total score improved from 45.2 preoperatively to 74.8 at latest follow-up in the varus group and from 40.5 preoperatively to 72.3 at latest follow-up in the nonvarus group. Patient satisfaction was >85%.

Conclusion:

Patients undergoing isolated OCA transplantation of the MFC had high rates (>90%) of graft survivorship and significant improvements in pain and function. Patients with mild preexisting varus malalignment were found to have no difference in the failure rate or clinical outcomes compared with patients with nonvarus alignment.
Misinformation, Free Speech and Accountability in Health Communications
Authors: Terry Paul E.
Published: September 2024

Some have argued that nothing less than truth and freedom is on the ballot in the 2024 election. To be sure, fact checking politicians has become a commonplace element of vetting candidates for public service. This editorial reviews trends in the use of media to influence opinions and practices relating to health promotion and disease prevention. Has society been striking the right balance between protecting free speech while also holding individuals and organizations accountable when disinformation they promulgate causes harm? If we are to protect freedom of speech, one of America’s hallmarks to democratic governance, health professionals need to develop more innovative and effective methods for curbing misinformation and for countering the ills created by super spreaders of misinformation.
Barriers and Facilitators in Lactation Support for the Preterm Mother–Infant Dyad: An Integrated Approach
Authors: Eerdekens An , Debeer Anne
Published: September 2024

Breastfeeding offers significant health benefits for both mothers and infants, particularly preterm infants, where it serves as a therapeutic strategy to reduce mortality and morbidities. However, breastfeeding practices are threatened globally by societal norms and systemic barriers at both micro and macro levels. This paper explores the complex interplay of these barriers and facilitators, focusing on the Neonatal Intensive Care Unit (NICU) setting. Preterm infants face specific feeding challenges due to immature physiological functions, yet evidence supports that strategies like cue-based feeding and individualized care can enhance feeding success and health outcomes. For mothers, initiating and maintaining lactation after preterm birth is critical but challenging, with early lactation support and achieving sufficient milk volume being key predictors of success. Partner support significantly influences lactation outcomes, although more inclusive research is needed for diverse family structures. In the NICU, a multidisciplinary approach to lactation care is vital, emphasizing the need for experienced staff and family-centered practices. NICU design, policies promoting parental presence, and adherence to Baby-friendly Hospital Initiative guidelines further support breastfeeding. This paper aims to provide directives for local breastfeeding policies through an integrated approach, considering societal attitudes and healthcare practices. The findings advocate for improved lactation support in NICUs, inclusive language and policies, and further research into diverse familial and gender roles in breastfeeding.
Workplace Breastfeeding As Foodwork In Organizational Settings: Advancing Knowledge From Black, Low-Income Women In South Africa
Authors: Farista Feranaaz , Jaga Ameeta
Published: September 2024

The cessation of breastfeeding by low-income mothers returning to work is a feminist concern. Our research advances knowledge from the Global South to extend understanding of breastfeeding at work as a form of foodwork in organizational settings. A major reason for breastfeeding cessation is the conflict between this foodwork labor and the physical labor of paid employment. In-depth interview data from 33 black low-income working mothers in South Africa were analyzed through an intersectional lens of race, gender, and social class. The findings yield both struggles and innovations in the mothers’ attempts to combine nourishing their children with paid employment. The paper explores three themes: (1) the labor of breastfeeding within contexts of low-income earning, (2) gender and social class norms shaping childcare and foodwork, and (3) local knowledge about foodwork and employment. We present recommendations for improving workplace support for low-income mothers’ breastfeeding efforts, and for advancing gender equity.
The micro-dynamics of peace and conflict
Authors: Brett Roddy , Ginty Roger Mac , Sagherian-Dickey Thia , Voyvodic Clara
Published: September 2024

The study of micro-dynamics has grown over the last two decades, emerging now as a mainstay in research on peace and conflict. The focus on micro-dynamics, and other micro-level approaches, challenges the primacy of state-centric research. Yet despite the growing literature around the micro-dynamics of conflict and peacebuilding, the term remains opaque. Its use has evolved beyond a sweeping indicator for ‘subnational’, yet the field of study has seen limited development of the definitional parameters of the term and why the term retains utility. In this article we explore the deployment of the concept in distinct literatures, provide a working definition, and assess its application to the study of peace and conflict. We argue that micro-dynamics are simultaneously a unit of analysis, a social phenomenon and a sense-making tool for understanding human relations in the broader societal ecosystem. We contend that a micro-dynamics approach contributes to peace and conflict studies, offering insight into how individuals get on with their lives in conflict-affected areas. By providing multilayered insights of complex scenarios based upon thick, empirically led inductive analysis, the micro-dynamics lens generates a granular understanding of (i) how individuals and groups live and perceive boundaries and (ii) the shifting and malleable nature of inter- and intragroup relations in conflict-affected societies. A micro-dynamics lens, moreover, evidences (iii) the interconnected nature of the micro- and other scalar levels of analysis, elucidating understanding of what we characterize as the peace and conflict ecosystem.
Analysis of the Effect of Asymptomatic Carotid Atherosclerosis Study on the Outcome and Volume of Carotid Endarterectomy
Authors: Darling R. Clement , Kreienberg Paul B. , Roddy Sean P. , Paty Philip S.K. , Chang Benjamin B. , Lloyd William E. , Shah Dhiraj M.
Published: September 2024

Recent studies have demonstrated the benefits of carotid endarterectomy (CEA) and risk factor control in preventing stroke in asymptomatic patients. In this study, the effect of the asymptomatic carotid atherosclerosis study (ACAS) on the frequency of CEAs performed and the outcome of such procedures on symptomatic and asymptomatic patients were analyzed.

From 1990 to 1996, all patients undergoing CEA were prospectively entered into a computerized vascular registry. The number of procedures, indications, demographics, and early and late results were analyzed and compared with similar data compiled prior to the ACAS study.

The total volume of CEAs performed increased from 66 in 1990 to 719 in 1996 (ratio 1:12.3). The ratio of symptomatic to asymptomatic patients changed from 1.75:1 in 1990 to 1:1.52 in 1996. The combined stroke/mortality rate dropped from 4.75% in 1990 to 2.15% in 1996. The stroke mortality in the asymptomatic group decreased significantly from 4.3 to 1.9% in the pre and post-ACAS groups respectively ( P < 0.0005). The stroke mortality of symptomatic patients remained constant at 2.1 and 1.4% respectively.

Since the completion of ACAS in 1993, the number of CEAs performed on our service has increased tenfold. An increase in volume has translated into an improved stroke/mortality rate and significantly decreased length of stay.
Carotid Endarterectomy in Octogenerians
Authors: Ting Albert C. W. , Taylor David C. , Salvian Anthony J. , Chen Jerry C. L. , Strandberg Sandy , Hsiang York N. H.
Published: September 2024

Purpose:

The purpose of this study was to determine the safety and efficacy of carotid endarterectomy (CEA) in octogenerians.

Methods:

The records of 59 CEA performed in 57 patients who were 80 yr or older between April 1993 and September 1998 were reviewed. There were 33 males and 24 females with a mean age of 82. Forty-nine procedures (83%) were performed for symptomatic carotid stenosis. The perioperative mortality and morbidity including neurological events were recorded. Long term follow-up data was also obtained.

Results:

There were three perioperative deaths (5.1%) and three perioperative neurological events, including one stroke (1.7%) and two transient ischemic attacks (3.4%). The combined mortality and stroke rate was 6.8%. With a mean follow-up of 25 ± 21 months, Kaplan-Meier estimates of the 4-yr survival rate, freedom from stroke, and stroke free survival were 78. 94 and 75% respectively. For comparison, during the same time period, the same group of surgeons performed 597 CEA in patients less than 80 yr of age. The perioperative mortality and stroke rate was 0.3 and 2.5% respectively, with a combined mortality and stroke rate of 2.7%. Perioperative mortality was significantly higher in patients over 80 yr of age ( P < 0.01).

Conclusions:

CEA in octogenerians is associated with a higher mortality rate than in younger patients. However, good long term survival and freedom from stroke make CEA beneficial in octogenerians. With careful patient selection and perioperative management. CEA in octogenerians is worthwhile and should be advised in selected patients.
Carotid Endarterectomy Outcomes Research: Reduced Resource Utilization Using a Clinical Protocol
Authors: Hobart Dona C. , Nicholas Gary G. , Reed James F. , Nastasee Susan A.
Published: September 2024

Background and purpose:

The purpose of this study was to examine the necessity of intensive care unit (ICU) utilization following carotid endarterectomy (CEA) and to identify patients who can be managed postoperatively on a vascular unit using a clinical protocol.

Methods:

Medical records of 50 patients admitted to the ICU following elective CEA were reviewed retrospectively for patient characteristics, morbidity, mortality, length of stay (LOS), and ICU intervention. Prospectively, the next 200 patients were routed to either a vascular unit or ICU, based on a clinical protocol. Endpoints were mortality, stroke, myocardial infarction, total hospital LOS. ICU LOS. and ICU intervention.

Results:

There were no significant differences in morbidity or mortality between patients admitted to the vascular unit and those admitted to the ICU. Of patients evaluated prospectively, 129 (63%) were admitted directly to the vascular unit. Of the 73 patients admitted to the ICU, 63% required direct intervention compared with only 54% of patients in the retrospective series ( P = 0.001). In addition, after institution of the protocol, ICU LOS decreased significantly from 1.4 to 0.6 days (P < 0.001). The hospital cost savings using this protocol averaged $1043 per patient.

Conclusions:

A clinical protocol can select patients for admission to the ICU or the vascular unit following CEA without increase in morbidity or mortality. Selective use of the ICU conserved resources, decreased ICU LOS. and provided substantial cost savings.
Routine Minimally Invasive Aortic Valve Procedures
Authors: Lee Jae-Won , Lee Sang-Kwon , Choo Suk-Joong , Song Hyun , Song Meung-Gun
Published: September 2024

Background:

Due to the lack of objective evidence supporting the advantages and early technical difficulties, minimally invasive aortic valve procedures were performed on a highly selective rather than routine basis.

Methods:

From September 1997 to February 1999, one surgeon routinely used upper or transverse minimally invasive sternotomy to perform 46 consecutive cases of aortic valve procedures (M), whereas two other surgeons performed 40 aortic valve procedures through a conventional sternotomy (C).

Results:

More time consuming and technically demanding surgeries were done in M. There was one death in each group. Aortic clamp time was longer in M (93 ± 40 vs 59 ± 24 min, P = 0.001). There were no differences in operating time, pump time, intubation duration, bleeding and intensive care unit stay. The advantages of minimally invasive aortic valve operation included better postoperative ejection fraction (58 ± 17 vs 51 ± 10%, P = 0.04), decreased pain score (3 ± 2 vs 5 ± 2, P = 0.004), less transfusion (19 vs 55%, P = 0.02), shorter duration of chest tube drainage, and cosmetically more acceptable surgical wound (6.8 ± 2.2 vs 5.2 ± 2.0. P= 0.018). From our series, we could not find any negative effects of minimal access surgery.

Conclusions:

Our study demonstrated that aortic valve surgeries could be performed routinely by the minimally invasive approach with a high degree of effectiveness and safety.
Combined Minimaly Invasive Surgery for Coronary Bypass and Abdominal Aortic Occlusion
Authors: Alexandrescu V. , Bergeron P. , Perrin R. , Khanoyan P. , Rosario R.
Published: September 2024

Association of extracorporal assisted coronary bypass with peripheral vascular surgery has already placecommon in the therapeutic arsenal. This case report presents a combined cardiac and vascular surgery in a high risk patient, with unstable angina following myocardial infarction and critical ischemia of a single lower limb. Synchronous minimally invasive direct coronary bypass graft and extra-anatomic aorto-profundal bypass in one single sitting were performed. The procedure was successful at 6 months follow up. We believe that this type of synchronous procedure, minimising surgical agression, could be effective in selected high risk patients.
Diagnosis of Limbs and Neck Arterial Trauma Using Duplex Ultrasonography
Authors: Kuzniec S. , Kauffman P. , Molnár L. J. , Aun R. , Puech-Leão P.
Published: September 2024

Objective:

To evaluate duplex ultrasonography for diagnosis of arterial trauma in limbs and neck.

Method:

Fifty-one wounds in 47 patients, with indication for arteriography, were prospectively studied and grouped according to the presence (PCS group: 21 wounds, 41.2%) or absence (ACS group: 30 wounds, 58.8%) of clinical signs of arterial injury. All underwent duplex ultrasonography and arteriography.

Results:

Arteriography disclosed arterial injury in 21 wounds, of which 19 were visualized by duplex ultrasonography. In the other 30 wounds neither methods disclosed any arterial injury. The sensitivity of duplex ultrasonography was 90.5%, the specificity was 100% and the accuracy was 96.1 %. In PCS group duplex ultrasonography showed 14 injuries (93.3%) and one false-negative result, and in ACS group, five injuries (83.3%) and one false-negative result in the ACS group.

Conclusions:

Duplex ultrasonography reproduces the results of arteriography as a non-invasive diagnostic method in trauma of the limbs and neck.
Use of the Right Gastroepiploic Artery as a Coronary Artery Bypass Graft in 307 Patients
Authors: Albertini A. , Lochegnies A. , El Khoury G. , Verhelst R. , Noirhomme P. , Matta A. , Jacquet L. , Underwood M. J. , Dion R.
Published: September 2024

From October 1988 to October 1995 the right gastroepiploic artery was used as a conduit for coronary surgery in 307 patients. Their average age was 56.5 years (range 25–75) and 274 patients (89%) were male. Twenty-six cases (8.5%) were re-operations and 58 patients (19%) were operated upon on an urgent or semi-urgent basis. Target coronary vessels were the right coronary artery and its branches in 280 cases (91.4%). the circumflex artery in 25 cases (8%) and the left anterior descending artery in two cases. The right gastroepiploic artery was used as an in situ graft in 303 cases (98.7%) and as a free graft in 4 (1.3%). A total of 291 patients (94.8%) also received at least one mammary artery graft: both mammary arteries were used in 167 patients (54.4%). An average of 3.6 distal anastomoses were made per patient, three of them with arterial grafts. Eleven (3.2%) right gastroepiploic artery grafts were doubled with saphenous vein intraoperatively because of persistent myocardial ischemia. In-hospital mortality was 1.6% (five patients). Perioperative myocardial infarction occurred in twelve patients (3.9%). Follow-up now averages 26 months (range 6–88). There have been five late deaths (1.6%). A total of 265 (89.2%) patients are angina free. Of the total, 145 patients have been investigated with a maximal-stress test coupled with scintigraphy: residual myocardial ischemia was found in 10 patients, right gastroepiploic artery was related in three. Ninety-six patients have undergone angiographic restudy at a mean of 12 months (range 8–88) postoperatively. Patency of the right gastroepiploic artery grafts was 91.8%. This study confirms that the right gastroepiploic artery can be used as a conduit for coronary artery bypass surgery with minimal mortality or morbidity. Mid-term patency rates and clinical outcome are encouraging.
Combined Carotid Endarterectomy and Coronary Artery Bypass Grafting Does Not Increase the Risk of Perioperative Stroke
Authors: Darling R. C. , Dylewski M. , Chang B. B. , Paty P. S. K. , Kreienberg P. B. , Lloyd W. E. , Shah D. M.
Published: September 2024

Patients who present for coronary artery bypass grafting with hemodynamically significant carotid artery lesions pose a difficult problem for both the cardiac and vascular surgeons. There is no consensus as to the proper management of these patients despite numerous studies. Prospective collection of data was performed in patients undergoing combined carotid endarterectomy and coronary artery bypass grafting's from April 1980 to November 1996. A total of 470 simultaneous carotid endarterectomy's and coronary artery bypass grafting's were performed in 420 patients. The average age of the patient was 69 years, with 62% being male, 15% being diabetic and 38% being smokers. Sixty (13%) presented with Transient ischemic attacks, 22 (5%) presented with amaurosis fugax, 16 (3.4%) presented with a prior history of stroke and 372 (70%) were asymptomatic. Operative mortality was 2.4% or 10 patients; 90% of those patients died from cardiac complications postoperatively and one patient died of a stroke. Permanent neurological deficits occurred in five (1%) of the patients, and six (1.7%) of the patients had a transient neurological deficit that improved prior to discharge. In conclusion, in our experience simultaneous carotid endarterectomy with coronary artery bypass grafting can be performed with an acceptable mortality and morbidity and does not appear to put the patient at a higher risk than when either procedure is performed alone.
Fibrinogen and Fibrinolysis in Blood and in the Arterial Wall: Its Role in Advanced Atherosclerotic Disease
Authors: Martin-Paredero V. , Vadillo J. , Diaz J. , Espinosa A. , Berga C. , Segura J. , Sanchez J. , Barbod A. , Villaverde C. , Richard C. M.
Published: September 2024

High plasma fibrinogen appears to be an important risk factor for the development of atherosclerosis. The aim of our study was to measure fibrinogen and fibrin degradation products (D-dimer). interleukin-6 tissue plasminogen activator, plasminogen activator inhibitor-1 and urokinase-type plasminogen activator in the plasma and arterial walls of 45 patients who had arterial surgery between April 1993 and November 1995. The arterial specimens were also examined by immunohistochemists for these same factors. The serum fibrinogen and fibrin degradation products were high in all patients, and fibrinolysis was depressed. Few leukocytes were seen in the arterial walls, which had poor fibrinolytic activity. Plasminogen-activator inhibitor activity in the wall was also reduced in the affected arterial walls. The abdominal aorta appeared to have the highest levels of fibrinogen and this may be related to its ability to form aneurysms. Fibrinogen may play an important role in the progression of atherosclerotic disease.