bluuebunny/crossref_metadata_2025 huggingface dataset:
Woke
Authors: Jackson Anthony J. , Katz-Fishman Walda
Published: September 2024

This chapter explores the collective materiality of exploitation, oppression, White supremacy, and patriarchy, and evaluates the growing death and destruction under the system of capitalism in the 21st century. It offers a call to action despite the seemingly irreversible crisis of capitalism in this new historical moment and answers essential questions around what it means to be woke in relation to the revolutionary process in this moment. It discusses the philosophical and theoretical foundations of wokism and its relationship to revolutionary education and the critical and liberatory consciousness that is produced. It theorizes two types of woke activists—woke reformists and woke revolutionaries. It illuminates woke revolutionary intellectuals, embracing their legacies and highlighting lessons learned from their contributions to revolutionary education. It ends with the hope and possibility of liberation, emphasizing the need for revolutionary education.
Be the Moose
Authors: Johnson Austin H.
Published: September 2024

Pathways to and experiences of sociology for social justice are as diverse as the life course experiences of those who practice it. The author’s own experiences as a working-class, transgender sociologist from the southeastern United States has shaped his own career within this branch of sociology. Through critical narrative informed by sociological theory, this chapter offers a snapshot of the ways that sociology can shape individual and collective identities, how it can be used to understand and address experiences of social marginality, and how it might inform social change at multiple levels of social life.
Social Justice in the Academy and Beyond
Authors: Messineo Melinda
Published: September 2024

There are numerous movements within higher education that strive to increase social justice through inclusive practices. Specifically, the efforts around antiracist/decolonizing and inclusive pedagogies, equity-focused rewards, efforts at building belonging, and community engagement leverage the strengths of sociology as a means to increase social justice in the academy. Starting with the phenomenon of “Middletown”, this chapter explores these approaches within the context of a program that began as a service-learning experience but developed into a community-engaged partnership based in reciprocity. It provides readers with strategies to apply these methods of praxis in their own campus and community contexts. Inherent in these efforts is the tension between trying to facilitate transformative experiences within the bureaucratic structures of higher education. Working within a severely challenged system, we pose the question of whether or not sociology can reach the ideals of inclusion it promises to the communities and students it serves.
Assessing Banking System Transformation and Financial Sector Reforms in the Post-Socialist Transition Economies
Authors: Nakamura Yasushi
Published: September 2024

The transition economies in East Europe and the former Soviet Union had to build a banking system from scratch in difficult economic conditions where the socialist system had left them with nonperforming financial assets and low-productivity physical capital. This chapter evaluates the present reach of banking and financial reform in the transition countries stemming from this situation, focusing on the fundamental role of the financial sector to increase the efficiency of converting mobilized domestic and foreign savings into economic growth. The efficiency was estimated with a Bayesian hierarchical model using data from countries around the world from 1990 to 2021. The results show that both East Europe and the former Soviet Union significantly increased converting efficiency; however, there seems to be room to increase it to increase it even more by further advancing financial reforms. The reliability of the estimation results for the period after 2008 is questionable due to the increased geopolitical tensions in the former Soviet Union countries and the Covid-19 pandemic. It is necessary to monitor the progress of the financial reform further.
The Role of Emotions in Foreign Policy Decision-Making
Authors: Ghalehdar Payam
Published: September 2024

Recent international relations scholarship has made great strides in studying the impact of emotions on foreign policy decision-making. This chapter takes stock of the current state of the literature, focusing on three prominent elements of foreign policy: decision-making processes, foreign policy behavior, and basic rules of foreign policy. It demonstrates the role that emotions play at the level of each of the elements of foreign policy, including the emotional basis of grand strategy. This is followed by a discussion of prevalent ways to identify emotions and the level-of-analysis problem. Regarding the former, the chapter presents techniques to deal with the challenge of identification. Regarding the latter, it argues for the political relevance of individual-level emotion and against the notion that emotions must scale up in order to become politically consequential.
Emotions as Tools for Action
Authors: Van Rythoven Eric
Published: September 2024

This chapter makes the case for a pragmatist approach to emotion in International Relations (IR) where emotions are understood as tools for social action. Critical of how various dualisms (e.g., biology vs. culture, individual vs. collective, etc.) hamper emotions research, this chapter shifts the perspective to pragmatism’s distinctive view of social action as creative problem-solving. The central wager is that scholars would benefit from examining how social actors—including states, nongovernmental organizations, terrorist groups, and beyond—use emotions as “tools” to solve problems in global politics. To illustrate the argument, the chapter shows how emotions can be understood as tools for communication, sense-making, collective mobilization, and disciplining. The conclusion addresses how pragmatism’s distinctive view of social action highlights the possibility that emotions which serve as “tools” in one context can become “problems” in another.
Challenging Caste Hierarchies in Tamil Cinema
Authors: Eswaran Swarnavel
Published: September 2024

Caste played a significant role in Tamil cinema before and after the independence of India, and it does to this day. The Gandhian imperatives of an egalitarian society predicated on the upliftment of Harijans played a significant role in films such as Seva Sadanam (House of Service, 1938) and Thyaga Bhoomi (Land of Sacrifice, 1939), directed by K. Subramanyam. In addition, immediately after independence, the Dravidian ideologues, including Annadurai and Karunanidhi, questioned caste hierarchy and oppression in films such as Velaikkari (1949) and Parasakthi (1952). They interrogated irrational belief and exploitation in the name of religion through the character of the wicked priest and by rendering the temple precincts insecure for women. However, the most critical intervention in recent times has been through Dalit cinema, as spearheaded by Pa. Ranjith, whose films, including Attakathi (2012), Madras (2014), Kaala (2016), and Kabali (2018), challenge and undermine caste hierarchy.
Media Representations, Incarceration, and Social Justice
Authors: Key Adam
Published: September 2024

Although significant attention has been paid toward the mediated representation of many minoritized groups, the portrayal of the incarcerated largely remains undiscussed. Despite this lack of research, the public perception of prisoners as irredeemably violent and worthy of maltreatment shapes public policy dealing with prisoners and is shaped by mediated representations. This chapter seeks to help increase the critical understanding of these representations and provide the tools to challenge them. Using the frame of convictism, a measure of bias against prisoners and criminals, it provides a means to analyze and chart bias against the incarcerated on both macro and micro levels. In addition, the chapter provides a comprehensive review of existing literature as well as a summary of current research into depictions on streaming platforms.
Alternative Cultures of Resistance and Collective Organizing in the Platform Economy
Authors: Soriano Cheryll Ruth R.
Published: September 2024

This chapter examines the forms of resistance and collective organization emerging from among location-based platform workers in the Philippines. During the past decade, digital labor platforms offering ride hailing, as well as food and last-mile delivery services, have attracted high numbers of workers in the region. The chapter examines how workers identify “new targets” to bargain with, new “repertoires of struggle,” as well as the material dimensions of these resistant and organizational forms. Juxtaposing the Philippine platform labor experience against worker mobilizations in the Global South, the chapter also outlines the role of communication and media technologies in these collective expressions.
An Evolution of Socioeconomic Inequality in Health Care Access in Malawi
Authors: Chirwa Gowokani Chijere
Published: September 2024

This chapter explores the evolution of socioeconomic inequalities in healthcare access in Malawi. Data for the chapter comes from three rounds of the nationally representative Integrated Household Surveys (IHS) of 2005, 2010, and 2016. Concentration curves and concentration indices were used to assess the socioeconomic inequality in health care access. The findings indicate that the concentration curves show more use of health care by wealthier individuals. This is also supported by the concentration indices for health care access, which were positive and increasing in value. These findings mean that universal health coverage may not be achieved as many people are already being left behind due to a lack of access to health care. Therefore, there is a need for policies such as intensifying mobile clinics and health cards for the less privileged to address the factors that contribute to this disparity in health care access.
Socioeconomic Impact of Covid-19 on Household Welfare in Malawi
Authors: Awel Yesuf M. , Chavula Hopestone Kayiska
Published: September 2024

This chapter assesses the socioeconomic impact of the COVID-19 pandemic on households in Malawi using data from the Malawi Integrated Household Survey, Wave 5. The analysis is based on a simple COVID-19 sectoral impact assessment framework combined with a microeconomic analysis at household level to quantify the effect of COVID-19 and the potential effectiveness of social protection interventions in the country. It finds that the pandemic increased consumption losses, translating into a significant rise in poverty of up to 8.2 percentage points from the pre-crisis level. It also shows the negative effects of the pandemic to be heterogenous by households’ area of residence and gender. The chapter emphasizes the need to mitigate the adverse effects of the pandemic through timely social protection schemes adapted to effectively respond to the heterogenous impact of the pandemic on household welfare.
The Presidency and Constitutionalism in Malawi
Authors: Nkhata Mwiza Jo
Published: September 2024

The Constitution of the Republic of Malawi stipulates, in clear and unambiguous terms, its supremacy over all laws in the country. One of the most important offices that it establishes is the presidency. This chapter is an interrogation of the presidency through the prism of constitutionalism. It demonstrates that, thus far, presidents in Malawi have shown a tendency to arrogate to themselves authority over and above that permitted by law. To improve the myriad governance issues facing Malawi, the chapter proposes, among other things, reforming the vice presidency, reinvigorating the oversight functions among the branches of government and harnessing the law to support good governance.
Aquaculture Policy Analysis Through Stakeholders’ Perception in Malawi
Authors: Jere Wilson Wesley Lazaro , Chirwa Elias
Published: September 2024

The chapter investigates stakeholders’ perceptions of policy changes implemented to spur aquaculture production in Malawi and to determine if these policies generate intended outcomes. Despite its long history dating back to the 1950s, aquaculture production has failed to bridge the gap between fish supply and demand. Several policy changes and initiatives have been implemented to spur aquaculture production, such as genetic improvement programmes for indigenous fish species and the removal of taxes on fish feed imports and machinery for manufacturing fish feed. The study reveals that these efforts have created conflicting expectations among stakeholders. Among others, while farmers welcomed tax removal on fish feed imports as this would increase availability on the local market, local feed producers were afraid that cheap feed imports would kill the domestic feed manufacturing industry. The study recommends that aquaculture policies should not have opposing goals and should take into account aspirations of all stakeholders.
An Empirical Analysis of Malawi’s Manufacturing Productivity Growth
Authors: Chavula Hopestone Kayiska
Published: September 2024

Since independence, the Malawian economy is believed to have undergone three distinct economic policy regimes: the import substitution period; the structural adjustment period; and the liberalized open economy era. Despite these policy regime changes, Malawi’s manufacturing sector’s contribution to the country’s economic and productivity growth has remained low. The objective of this chapter is therefore to identify policy options and the associated targeted areas that could enhance productivity and hence long-term growth in Malawi. This is done by decomposing the sector’s total factor productivity growth using the stochastic frontier approach over the period 1969–2015. The results show that the sector’s output growth has mainly been input-driven and productivity has mainly been driven by technological progress, albeit low, while the sector has mostly been technically inefficient. This calls for policies to reduce inefficiency and improve technological progress, through enhanced utilization of digital technologies and human capital with conducive macroeconomic environment.
Africa’s Integration and the African Continental Free Trade Area
Authors: Chinyama Emmanuel Joshua
Published: September 2024

rican countries continue to implement various policies and strategies aimed at establishing the African Economic Community as envisaged in the Abuja Treaty of 1991. The chapter examines some of the initiatives being implemented by African countries at national, regional, and continental levels, including the African Continental Free Trade Area (AfCFTA), to identify the associated economic opportunities and challenges for Malawi. It focuses on how Malawi could fully reap the benefits arising from the establishment of a single market, while drawing lessons from existing regional blocs, such as the Southern Africa Development Community and the Common Market for Eastern and Southern Africa. It examines the key role that the AfCFTA could play in promoting the country’s economic growth and development. The findings reveal that Malawi would significantly benefit from these regional initiatives, especially the AfCFTA, if it creates the necessary macroeconomic and trade environment, despite some challenges in the short to medium term.
Conclusion
Authors: Chavula Hopestone Kayiska , Ngalawa Harold P. E. , Dulani Boniface , Munthali Thomas Chataghalala
Published: September 2024

The chapter takes stock of the findings from the chapters in this volume and distils key lessons into a policy framework to address the envisaged key challenges and bottlenecks that have or may derail the country’s growth and development, with the aim of shaping its long-term growth and development trajectory. Drawing on the available literature and new evidence adduced in this book, the chapter discusses policies and strategies that could enhance and strengthen Malawi’s long-term growth and development. The policy framework could assist in achieving and sustaining the country’s long-term growth, equity, and poverty reduction, by delving into the importance of good governance practices and effective institutions; effective fiscal and monetary policies; agricultural sector development and transformation; the importance of eliminating human condition imbalances related to employment, income, inequality, nutrition, health, and education; sustainable industrialization; and economic diversification, while harnessing digital technologies, climate-resilient measures and practices, and the AfCFTA.
The Political Economy of Global Health
Authors: Fischer Sara Elisa , Chasukwa Michael
Published: September 2024

This chapter investigates the phenomenon of parallel systems for global health projects in Malawi. Whereas donors have committed to a set of aid effectiveness principles, their practices at the point of action often belie these commitments. Drawing on the literature on aid effectiveness for development, this chapter therefore argues that despite the common rhetoric on ownership and alignment with government policies, donor-funded projects still sometimes create parallel systems—through hiring practices, project implementation, or other aid delivery mechanisms—that undermine the health systems-strengthening goals they claim to uphold. Using intensive ethnographic methods, this chapter illustrates various ways through which parallel systems are created, and how these are often overlooked or justified as reasonable decisions on the part of project staff. These findings have implications for global health practice, developing country governments, and donor practice, and they provide evidence of a common problem in the political economy of development.
Inflation Dynamics, Output, and Monetary Policy in Malawi
Authors: Ngalawa Harold P. E.
Published: September 2024

Monetary authorities in Malawi are mandated to pursue a low inflation strategy and ensure sustainable output growth and low unemployment. However, literature suggests that in order to achieve price stability, an understanding of the inflation–output relationship is essential, because the effects of monetary policy are dependent on their symmetric or asymmetric relationship and whether the asymmetry is convex or concave. This chapter empirically investigates this relationship by deriving and estimating a variant of the inflation expectations-augmented Phillips curve derived from the Lucas ‘surprise’ aggregate supply function using the generalized method of moments. The study finds a concave asymmetric Phillips curve, implying that the cost of lowering inflation following a positive demand shock is different from the cost of stimulating output growth following a negative demand shock of equal magnitude. Therefore, policymakers are expected to react swiftly when the economy shows signs of weakening rather than when it shows signs of strengthening.
Coalition Politics in India
Authors: Sridharan Eswaran
Published: September 2024

This chapter is an attempt to relate coalition behaviour and outcomes in India with coalition theory and comparative experience, looking at the distribution of types of coalition and/or minority governments in India with those in long-standing democracies. From 1989 to 2019, India has had nine national elections in which no single party won a majority of seats in the first seven, 1989–2009, necessitating the formation of coalition governments, and even in 2014 and 2019 the majority-winning BJP included pre-electoral allies to form an oversized coalition. These coalition governments have consisted, especially since 1996, of a very large number of parties (6–12), comparatively speaking, and have also been minority governments in that the coalitions still needed support from parties not in the government for a legislative majority. This pattern is a deviation from international patterns of coalition government and needs to be explained. The chapter argues that the apparently counter-intuitive patterns in India, that do not seem to fit theory or comparative experience, are explicable if one takes into account the institutional features of the Indian political and electoral system.
State–Business Relations in India
Authors: Murali Kanta
Published: September 2024

This chapter analyses the evolution of state-business relations in India over time and addresses the following questions. How have state-business relations in India changed over time? How can we characterize the nature of business power in the licensing era and after economic liberalization? The analysis of state-business relations over time in this chapter highlights three central aspects. First, there is a marked and significant increase in business power since the onset of extensive market reforms in 1991. However, the relationship between state and business is not purely one-sided and the state continues to retain some avenues of leverage over business. Second, not only has business enjoyed considerable growth in its power; the nature of its power has changed after liberalization; business power in India has shifted from veto power to agenda-setting power. Third, as Sinha (2019) argues, the lines between state and business have become increasingly blurred in the liberalization era.
Indian Secularism at CrossroadsAn Interpretation
Authors: Bhargava Rajeev
Published: September 2024

Newly independent India had to decide the character of the newly instituted state and its relationship with religion. It had two options: either to have a polity that consolidates inter and intra-religious domination, a patriarchal, upper-caste dominated Hindu majoritarian state, or to have a secular state that blocks these tendencies and tries to reduce both these forms of domination. In 1950, when India was declared a republic, it chose the second option with the explicit objective of confronting both forms of institutionalized religious domination. In doing so, two distinctive conceptions of political secularism were developed: one, the Gandhian social project of communal harmony and the other, Indian constitutional secularism marked by the state’s critical respect towards and principled distance from all religions. Both these conceptions are in deep crisis today. This is partly due to (a) the failure to prevent the transformation of Indian religious experiences into early modern forms of European religion, (b) not properly grasping and defending its distinctiveness, (a) allowing it to be reduced to a mere minority-protection device whereby its connection with caste and gender -based religious oppression is severed, (d) failing to distinguish between a defensible identity-constituting religious communitarianism and a mutually antagonistic communalism and finally, succumbing to an opportunist political use of religion that I call party-political secularism.
The Political Economy of Macroeconomic Policy in India
Authors: Gupta Surupa
Published: September 2024

India’s macroeconomic policy has largely been driven by the need to create a stable environment for economic development and poverty reduction. In the immediate period after Independence, the concern for economic development led to policies that gave the government a central role in investment and production. By the 1970s, trade policy grew more protectionist trade policies and policies governing domestic and foreign investors more restrictive. A gradual reversal began after 1980 and in 1991, the Indian government undertook comprehensive liberalization of trade, investment and exchange rate policies, opening up most sectors to both domestic and foreign private investment. These new policies set the GDP growth rate on a higher path after 1980, reducing poverty on the one hand and increasing inequality on the other. This chapter shows that the executive enjoyed substantial autonomy in policymaking during the first 3 decades after Independence and embraced fiscal conservatism. However, the rise of diverse sectoral interests has led to a decline in autonomy. Policy-making during the more recent decades is marked by societal and sectoral demands, resulting in sharp increases in fiscal deficits. Higher levels of economic growth have allowed politicians the option of avoiding difficult reform decisions required to tame those deficits. At the same time, achieving higher growth rates in the future—a pre-requisite for continued economic development—will require sectoral reforms thus far thwarted by domestic politics. Overall, preferences of domestic businesses and large farm owners continue to shape most policies.
Novel immunotherapeutic approaches in gastric cancer
Authors: Yang Meng , Lin Wuhao , Huang Jiaqian , Mannucci Alessandro , Luo Huiyan
Published: September 2024

Gastric cancer is a malignant tumor that ranks third in cancer-related deaths worldwide. Early-stage gastric cancer can often be effectively managed through surgical resection. However, the majority of cases are diagnosed in advanced stages, where outcomes with conventional radiotherapy and chemotherapy remain unsatisfactory. Immunotherapy offers a novel approach to treating molecularly heterogeneous gastric cancer by modifying the immunosuppressive tumor microenvironment. Immune checkpoint inhibitors and adoptive cell therapy are regarded as promising modalities in cancer immunotherapy. Food and Drug Administration-approved programmed death-receptor inhibitors, such as pembrolizumab, in combination with chemotherapy, have significantly extended overall survival in gastric cancer patients and is recommended as a first-line treatment. Despite challenges in solid tumor applications, adoptive cell therapy has demonstrated efficacy against various targets in gastric cancer treatment. Among these approaches, chimeric antigen receptor-T cell therapy research is the most widely explored and chimeric antigen receptor-T cell therapy targeting claudin18.2 has shown acceptable safety and robust anti-tumor capabilities. However, these advancements primarily remain in preclinical stages and further investigation should be made to promote their clinical application. This review summarizes the latest research on immune checkpoint inhibitors and adoptive cell therapy and their limitations, as well as the role of nanoparticles in enhancing immunotherapy.
Ejectosome of Pectobacterium bacteriophage ΦM1
Authors: Eruera Alice-Roza , Hodgkinson-Bean James , Rutter Georgia L , Hills Francesca R , Kumaran Rosheny , Crowe Alexander J M , Jadav Nickhil , Chang Fangfang , McJarrow-Keller Klemens , Jorge Fátima , Hyun Jaekyung , Kim Hyejin , Ryu Bumhan , Bostina Mihnea
Published: September 2024

Podophages that infect gram-negative bacteria, such as Pectobacterium pathogen ΦM1, encode tail assemblies too short to extend across the complex gram-negative cell wall. To overcome this, podophages encode a large protein complex (ejectosome) packaged inside the viral capsid and correspondingly ejected during infection to form a transient channel that spans the periplasmic space. Here, we describe the ejectosome of bacteriophage ΦM1 to a resolution of 3.32 Å by single-particle cryo-electron microscopy (cryo-EM). The core consists of tetrameric and octameric ejection proteins which form a ∼1.5-MDa ejectosome that must transition through the ∼30 Å aperture created by the short tail nozzle assembly that acts as the conduit for the passage of DNA during infection. The ejectosome forms several grooves into which coils of genomic DNA are fit before the DNA sharply turns and goes down the tunnel and into the portal. In addition, we reconstructed the icosahedral capsid and hybrid tail apparatus to resolutions between 3.04 and 3.23 Å, and note an uncommon fold adopted by the dimerized decoration proteins which further emphasize the structural diversity of podophages. These reconstructions have allowed the generation of a complete atomic model of the ΦM1, uncovering two distinct decoration proteins and highlighting the exquisite structural diversity of tailed bacteriophages.
Advancing rheumatology with natural language processing: insights and prospects from a systematic review
Authors: Omar Mahmud , Naffaa Mohammad E , Glicksberg Benjamin S , Reuveni Hagar , Nadkarni Girish N , Klang Eyal
Published: September 2024

Objectives

Natural language processing (NLP) and large language models (LLMs) have emerged as powerful tools in healthcare, offering advanced methods for analysing unstructured clinical texts. This systematic review aims to evaluate the current applications of NLP and LLMs in rheumatology, focusing on their potential to improve disease detection, diagnosis and patient management.

Methods

We screened seven databases. We included original research articles that evaluated the performance of NLP models in rheumatology. Data extraction and risk of bias assessment were performed independently by two reviewers, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to evaluate the risk of bias.

Results

Of 1491 articles initially identified, 35 studies met the inclusion criteria. These studies utilized various data types, including electronic medical records and clinical notes, and employed models like Bidirectional Encoder Representations from Transformers and Generative Pre-trained Transformers. High accuracy was observed in detecting conditions such as RA, SpAs and gout. The use of NLP also showed promise in managing diseases and predicting flares.

Conclusion

NLP showed significant potential in enhancing rheumatology by improving diagnostic accuracy and personalizing patient care. While applications in detecting diseases like RA and gout are well developed, further research is needed to extend these technologies to rarer and more complex clinical conditions. Overcoming current limitations through targeted research is essential for fully realizing NLP’s potential in clinical practice.
Expiratory muscle strength training reduces oxidative stress and systemic inflammation in men with obstructive sleep apnea syndrome: a double-blinded, randomized parallel trial
Authors: Erturk Nurel , Celik Adem , Kahraman Yaman Sevim , Yaman Huseyin , Unal Ferhat , Calik Kutukcu Ebru
Published: September 2024

Study Objectives

This study aimed to evaluate and compare the effects of high and low-intensity expiratory muscle strength training (EMST) on disease severity, systemic inflammation, oxidative stress, respiratory muscle strength, exercise capacity, symptoms, daytime sleepiness, fatigue severity, and sleep quality in male patients with obstructive sleep apnea syndrome (OSAS).

Methods

Thirty-one male patients diagnosed with moderate OSAS were included in this double-blind, randomized, parallel study. Patients were randomized into two groups: High-EMST and Low-EMST groups. EMST was used at home 7 days/week, once a day, for 25 breaths, 12 weeks. Respiratory muscle strength was measured using a mouth pressure device. Disease severity (Apnea–Hypopnea Index [AHI]) and, respiratory sleep events by polysomnography, total oxidant level(TOS), total antioxidant level(TAS), oxidative stress index (OSI), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels by blood serum were evaluated.

Results

The percentage of AHI change in the high-EMST group(50.8%) was significantly higher than in the low-EMST group(6.3%; p = .002, d = 1.31). In general, as MEP increased by one unit, AHI decreased by 0.149 points (b = −0.149; CR = −3.065; p = .002), and as AHI increased by one unit, ODI increased by 0.746 points (b = 0.746; CR = 10.604; p < .001). TOS, OSI, TNF-α and IL-6 levels decreased at similar rates in both groups.

Conclusions

EMST significantly reduces systemic inflammation and oxidative stress while improving expiratory muscle strength in male patients with moderate OSAS. High-EMST is more effective in enhancing the severity of disease than low-EMST. EMST is a practical, effective, and promising treatment for pulmonary rehabilitation in patients with moderate OSAS.

Clinical Trials

Effect of EMST systemic inflammation and oxidative stress in patients with moderate OSAS, https://clinicaltrials.gov/study/NCT05242406, with the number NCT05242406.
Research Agenda and Applications for Preliminarily Validated Measures of d/Deaf and Hard of Hearing Stigma
Authors: Stelmach Rachel D. , Musa Lawrence G. , West Jessica S. , Wallhagen Margaret I. , Kraemer John D. , Francis Howard W. , Stockton Melissa A. , McMahon Catherine , Smith Sherri L. , Nyblade Laura
Published: September 2024

In this special supplement of Ear and Hearing, we have presented preliminarily validated measures for stigma related to being d/Deaf or hard of hearing (d/DHH) in the United States and Ghana. In this concluding article, we suggest avenues for the future refinement and use of these measures. First, the measures should be further validated. Second, they should be used to assess the current state of d/DHH stigma and the importance of different kinds of stigma in different populations, which should in turn drive the development of interventions to reduce d/DHH stigma. Third, these measures can assist in evaluating the effectiveness and cost-effectiveness of those interventions. The evidence from this work can then inform investment cases and cost-of-condition studies, which will support advocacy efforts and policy development for reducing stigma and improving the lives of people who are d/DHH.
Development and Preliminary Validation of Stigma Measures for Care Partners of Persons Who Are d/Deaf or Hard of Hearing
Authors: Wallhagen Margaret I. , Kraemer John D. , Saalim Khalida , Adams Elizabeth Troutman , Stelmach Rachel D. , West Jessica S. , Chung Jenny Jae Won , Nyblade Laura
Published: September 2024

Objectives:

A great deal of literature documents the significant demands, both physical and psychosocial, that care partners experience when providing care to persons with a range of health conditions. There is, however, far less research available on care partners of adult persons who are d/Deaf or hard of hearing (d/DHH). In response to this gap, the authors developed measures of d/DHH stigma among care partners as part of the work of the Lancet Commission on Hearing Loss’ Measures, Models, and Stigma Reduction Subgroup. The measures examined in this article are part of a larger set of parallel measures to enable comparison of stigma measurement across groups.

Design:

The present study describes the preliminary validation of five stigma scales specifically tailored for use to assess the prevalence and effect of stigma on the care partners of adult people who are d/DHH in the United States. Care partners in this context are defined broadly and can include spouses, partners, adult children, siblings, and friends of persons who are d/DHH. The scales describe the care partner’s own assessment of how the person who is d/DHH experiences and perceives stigma as well as the care partner’s own internalized, experienced, and perceived stigma as a result of their association with a person who is d/DHH. This latter set of three scales describes secondary stigma, or the stigma a person experiences related to their association with a member of a stigmatized group. Measures were developed through a process that included a literature review, Delphi groups with people who became d/DHH after they developed spoken language, cognitive interviews, and a pretest. An online, self-administered preliminary validation survey was conducted with 151 care partners.

Results:

Results support the internal reliability of each of the five stigma scales (ordinal α’s all greater than 0.9) and that each scale is assessing a single factor.

Conclusions:

Additional testing is needed to confirm the validity of these measures. After further validation, they can be used to assess the prevalence and effect of stigma on care partners of persons who are d/DHH and to evaluate the success of interventions developed to address stigma and its effects both on the care partner and the person who is d/DHH and receiving the care.
Intramedullary Cylindrical Grafting for Nonunions of the Proximal Fifth Metatarsal
Authors: Seiça Emanuel Cortesão , Domingos Rui , Mendes Daniel , Vide João , Sousa Manuel Resende
Published: September 2024

Fractures affecting the proximal fifth metatarsal constitute 25% of all metatarsal fractures, being particularly prevalent in sports due to stress-related incidents. Recognizing fracture patterns and implementing precise management are pivotal to mitigate potential complications, given the proclivity for suboptimal bone healing, and high incidence of nonunions (up to 4% in zone 2/3 fractures). Various methods for graft collection and application have been outlined, ranging from inlay grafts to the straightforward application of bone grafts at the nonunion site. However, the use of inlay grafts may pose challenges in size accuracy and donor site morbidity. We present and describe a novel grafting technique, which we describe as intramedullary bone grafting, exposing its capacity to promote bone healing by filling the medullary canal with cancellous bone. Developed for the treatment of delayed unions or nonunions in zone 2 and 3 fractures of the proximal fifth metatarsal, this innovative technique amalgamates the advantages of both inlay grafting and cancellous grafting. Employing a compacted cylindrical graft, tailored to match the reamed canal’s dimensions, replaces the entire medulla, facilitating the bone healing process. The technique establishes an intramedullary bone bridge across the nonunion site without compromising cortical bone integrity, extending significantly above and below the site. This presents a possible alternative to conventional methods. Furthermore, we illustrate a case involving a professional athlete with a Torg-3 fracture nonunion in zone 3, who underwent this grafting technique alongside anatomic plate fixation. Following a 4-month follow-up, a CT scan revealed complete bone healing, yielding a painless and functionally restored foot. This success enabled the athlete to resume regular practice.

Level of Evidence:

Level IV.
Sleep Disturbances and Dry Eye Symptoms and Signs, Systemic Conditions, and Inflammatory Markers in the Dry Eye Assessment and Management Study
Authors: Huang Alan , Augello Patrick , Asbell Penny , Ying Gui-shuang ,   The DREAM Research Group
Published: September 2024

Purpose:

To investigate the association between sleep disturbances, dry eye disease (DED) severity, and DED risk factors.

Methods:

We conducted a secondary analysis of the Dry Eye Assessment and Management (DREAM) study, a randomized trial of 535 patients with moderate-to-severe DED. Participants self-reported sleep disturbances at baseline. DED symptoms were assessed using the Ocular Surface Disease Index and Brief Ocular Discomfort Index. DED signs were assessed using tear film break-up time, Schirmer test, corneal and conjunctival staining, tear osmolarity, and meibomian gland dysfunction assessment. Immune cells were assessed using conjunctival impression cytology. Outcomes were compared between participants with ongoing and no history of sleep disturbances, adjusting for confounders.

Results:

The mean age was 58 years, and 81% were women. Ongoing sleep disturbances (n = 113) were significantly associated with older age (mean 60.5 vs. 57.4; P = 0.03), smoking (39.8% vs. 28.7%; P = 0.02), and DED treatment. Systemic conditions associated with sleep disturbances included thyroid dysfunction (26.5% vs. 15.7% P = 0.007), irritable bowel (18.6% vs. 5.4%; P < 0.0001), osteoarthritis (38.9% vs. 21.6%; P = 0.0007), and depression (30.1% vs. 11.5%; P < 0.0001). Sleep disturbances were associated with lower conjunctival staining scores (2.46 vs. 2.77; P = 0.03) and higher concentrations of dendritic cells in ocular surface white blood cells (12.0% vs. 8.1%; P = 0.01).

Conclusions:

Sleep disturbances were associated with older age, smoking history, systemic diseases, and higher dendritic cell concentration among patients with moderate-to-severe DED. These findings support further investigation of sleep disturbances as a comorbidity of patients with DED. Additional research is needed to understand the mechanisms behind this relationship.
A Novel Shielding Device for Cardiac Cath Labs
Authors: Smith Lancer , Caffrey Emily , Wilson Charles
Published: September 2024

This research evaluates the effectiveness of a large specialized cardiac catheterization laboratory shielding device (SCCLSD) placed perpendicular to the patient compared to traditional shielding methods in reducing occupational exposure to scattered x rays, contributing to the ongoing enhancement of radiation safety in the cardiac catheterization laboratory (CCL) setting. An experimental setup involving an anthropomorphic phantom on the catheterization table simulated radiation scatter from a patient. Measurements were taken systematically at various grid points and heights in the CCL using a Fluke 451P ion chamber while mimicking a real interventional scenario. In-air peak exposure rates were analyzed at head, chest, and waist heights in the anteroposterior (AP) position. Results demonstrated that the SCCLSD provided a superior radiation shadow and effective whole-body radiation exposure reduction compared to conventional shielding devices. Considering that conventional shielding requires staff to wear lead aprons, an effective dose equivalent correction factor was applied for exposure measurements without the SCCLSD. Even after the correction factor, the SCCLSD continued outperforming lead aprons and offered whole-body protection, including the head and arms, which is typically neglected with conventional shielding. The SCCLSD also reduces exposure to the eyes, aligning with lower occupational exposure recommendations from ICRP and NCRP. However, proper CCL staff positioning is important in maximizing the effectiveness of the SCCLSD. Future research avenues may explore exposure rates at different C-arm angles to more completely assess the SCCLSD’s impact on occupational exposure.
The conotoxin Contulakin-G reverses hypersensitivity observed in rodent models of cancer-induced bone pain without inducing tolerance or motor disturbance
Authors: Martin Laurent F. , Almuslim Moyad , Ismail Khaled A. , Ibrahim Mohab M. , Moutal Aubin , Cheng Kevin , Stratton Harrison J. , Price Theodore J. , Vanderah Todd W. , Olivera Baldomero M. , Khanna Rajesh , Patwardhan Amol
Published: September 2024

As the incidence and survival rates of patients with cancer continues to grow, an increasing number of people are living with comorbidities, which often manifests as cancer-induced bone pain (CIBP). The majority of patients with CIBP report poor pain control from currently available analgesics. A conotoxin, Contulakin-G (CGX), has been demonstrated to be an antinociceptive agent in postsurgical and neuropathic pain states via a neurotensin receptor 2 (NTSR2)-mediated pathway. However, the efficacy and side effect profile of CGX have never been assessed in CIBP. Here, we evaluated CGX's antinociceptive potential in a rodent model of CIBP. We hypothesized that CGX engages the NTSR2 pathway, providing pain relief with minimal tolerance and motor side effects. Our results demonstrated that CGX intrathecal injection in mice with CIBP attenuated both spontaneous pain behaviors and evoked mechanical hypersensitivity, regardless of their sex. Furthermore, the antinociceptive effect of CGX was dependent upon expression of NTSR2 and the R-type voltage-gated calcium channel (Cav2.3); gene editing of these targets abolished CGX antinociception without affecting morphine antinociception. Examination of the side effect profile of CGX demonstrated that, unlike morphine, chronic intrathecal infusion maintained antinociception with reduced tolerance in rats with CIBP. Moreover, at antinociceptive doses, CGX had no impact on motor behavior in rodents with CIBP. Finally, RNAScope and immunoblotting analysis revealed expression of NTSR2 in both dorsal and ventral horns, while Cav2.3 was minimally expressed in the ventral horn, possibly explaining the sensory selectivity of CGX. Together, these findings support advancing CGX as a potential therapeutic for cancer pain.
A retrospective analysis on the effectiveness of cytokine hemadsorption in patients with severe coronavirus disease 2019
Authors: Tran Tuan DM , Thanh Tu Kim , Duy Luong Thai , Lam Dieu Ha
Published: September 2024

Background:

An increase in systemic inflammation due to hyperimmune activation leads to severe coronavirus disease 2019 (COVID-19) disease, acute respiratory distress syndrome, multiple organ failure, and ultimately death. Extracorporeal blood purification using hemadsorption to reduce excessive inflammatory cytokine was suggested as an effective treatment for patients with severe COVID-19. We investigated the effectiveness of intermittent cytokine hemadsorption with a HA330 cartridge in patients with severe COVID-19.

Methods:

We gathered data from severe COVID-19 patients who underwent hemadsorption using Jafron® (HA330) between October and December 2021. We assessed pre- and post-hemadsorption inflammatory cytokine levels, treatment complications, and mortality. Statistical significance was set at P < 0.05.

Results:

Of the total 40 patients, 13 (32.5%) were males with a mean age of 63.6 years. In patients who survived (n = 23), a 2-fold decrease in interleukin-6 (IL-6, P = 0.0433), a 3-fold decrease in procalcitonin (P = 0.0163), a 2.5-fold decrease in C-reactive protein (CRP, P = 0.0080), a 2.5-fold increase in D-dimer (P = 0.0337), and a 1.3-fold increase in white blood cell (WBC) (P = 0.0102) were observed before and after cytokine hemadsorption. In patients who died (n = 17), a 2-fold increase in WBC (P = 0.0022) was observed with no significant changes in other parameters. Except for a few cases of platelet transfusion, catheter occlusion, hypotension, and hematoma, no other complications were observed. A low rate of mortality (33.3%) was observed in patients who received 3 sessions of hemadsorption.

Conclusion:

Intermittent hemadsorption reduced inflammatory factors and improved outcomes of patients with severe COVID-19. Cytokine hemadsorption can be an effective therapeutic option for establishing inflammatory equilibrium. Our study was a non-comparator and single-center observational study. Larger studies like RCTs are warranted.