bluuebunny/crossref_metadata_2025 huggingface dataset:
Resection of orbital apex tumours in the medial orbit via four-handed endonasal and transcaruncular approaches
Authors: Takahashi Yasuhiro , Nishimura Kunihiro , Yo Kinga , Vaidya Aric
Published: September 2023

Purpose

To report the surgical outcomes of 4-handed endoscopic and transcaruncular approaches for orbital apex tumours located in the medial orbit.

Methods

This retrospective, observational study included 6 patients (2 males and 4 females; 3 right and 3 left; mean age, 49.5 years; age range, 38-60 years) who underwent excision of an orbital apex tumour in the medial orbit via 4-handed endonasal and transcaruncular approaches. Data on age, sex, affected side, surgical record and complications, and results of pathological examinations, imaging studies, and ophthalmologic examinations were collected.

Results

Tumours pathologically corresponded to a cavernous haemangioma in 5 cases and a schwannoma in 1 case. The cavernous haemangioma was completely removed in all cases, while the schwannoma was only debulked because the tumour attached to the surrounding tissues. The medial orbital wall was reconstructed simultaneously in 1 case and 8 days after tumour resection in 1 case. Postoperatively, the visual acuity improved or was maintained in all patients. One patient without medial orbital wall reconstruction showed significant enophthalmos on the affected side after surgery. Another patient without medial orbital wall reconstruction did not obtain binocular single vision field in any direction of gaze after surgery due to severe esotropia.

Conclusions

This report indicates that 4-handed endoscopic and transcaruncular approaches are useful for removal of an orbital apex tumour located in the medial orbit. Medial orbital wall reconstruction after tumour resection may be a better option for reducing the risk of postoperative enophthalmos and esotropia.
Complications of epicutaneo-caval catheters: Pericardial effusion and cardiac tamponade in three preterm infants
Authors: Köstekci Yasemin Ezgi , Bayram Özlem , Mertek Saniye , Bakhtiyarzada Jeyhun , Aydın Alperen , Yılmaz Mehmet Mustafa , Murt Begüm , Demirtaş Ferhan , Ramoğlu Mehmet Gökhan , Okulu Emel , Erdeve Ömer , Uçar Tayfun , Atasay Begüm , Eyileten Zeynep , Arsan Saadet
Published: September 2023

In the neonatal intensive care units (NICU), epicutaneo-caval catheters (ECCs) are common alternative vascular routes. Pericardial effusion (PCE) and cardiac tamponade (CT) are rare but serious complications in infants with ECCs. It may be asymptomatic or present with a variety of significant clinical signs, including dyspnea, bradycardia, sudden asystole, and hypotension. If untreated, PCE can be fatal. This report presents, three cases of ECC-associated PCE/CT during NICU stay. All three patients were born before 30 weeks of gestation and weighed less than 1500 g. Echocardiography was used for diagnosis all patients. PCE/CT was detected incidentally in one patient and after hemodynamic deterioration in the other two. In one patient, CT was developed due to catheter malposition, and the other two patient, the catheter tip was found in the right atrium. PCE did not recur in any of the patients after pericardial fluid was drained and the catheters were removed. No PCE/CT-related deaths were observed. In all three patients, X-ray was used to evaluate the location of the catheter tips. However, after clinical deterioration, echocardiography showed that in the first two cases the tips were actually in the right atrium. Real-time ultrasound was suggested with strong evidence to evaluate the location of the catheter tip and to detect secondary malapposition. PCE/CT should be considered in the presence of unexplained and refractory respiratory distress, abnormal heart rate and blood pressure, and metabolic acidosis in a neonate with ECC. Early diagnosis and prompt pericardiocentesis are essential to reduce mortality and improve prognosis. Prospective studies with educational interventions should be designed to demonstrate that the use of point-of-care ultrasound (POCUS) can be easily acquired and may reduce complications.
Carry-over effects of tourism on traditional activities
Authors: Perles José F. , Sevilla Martín , Ramón-Rodríguez Ana B. , Such María Jesús , Aranda Patricia
Published: September 2023

One of the justifications for promoting tourism development is the capacity that it has to generate spillover effects on traditional economic activities. However, the strength of these spillover effects depends, largely, on the complementary or competitive nature of the traditional sector with respect to the resources used by tourism. Using time series analysis techniques, this paper examines the relationship existing between tourism development and the local fisheries sector. The results suggest that fisheries have been benefiting from growth in tourism, not so much in terms of an increase in the volume of catches but rather due to an increase in their value.
Exploring collocational complexity in L2 Russian: A corpus-driven contrastive analysis
Authors: Kopotev Mikhail , Klimov Aleksandr , Kisselev Olesya
Published: September 2023

Objective:

The objective of this article is to discuss the pedagogical and practical need for automated assessment tools that enable teachers, researchers, and other language practitioners to relatively quickly and automatically assess the general proficiency of second language (L2) speakers according to a number of different linguistic parameters, specifically the use of collocations.

Introduction:

The Introduction discusses existing approaches to the concept of collocation and its role in L2 corpus studies.

Methods:

In the main part, Toward the automatic detection of collocational strength, we describe an approach to assessing collocations in Russian L2 written production, which is based on the corpus-driven contrastive analysis. In brief, this approach proposes ranking L2 collocations in accordance with the “collocational scores” of bigrams extracted from a reference (L1) corpus, with the assumption that the greater number of native-like bigrams in an L2 text and the higher collocational scores associated with them, the more proficient is the learner who created the text. To test this hypothesis, we conducted a series of experiments based on an L1 reference corpus and split the L2 datasets into four proficiency groups (Beginner, Intermediate, Advanced, and Superior).

Results and evaluation:

The findings, presented in the section Results and evaluation of the methods, established an empirical minimum and maximum of mean reciprocal rank (MRR) values, and the variation of the MRR across the four proficiency levels. In the last sections, we discuss shortcomings of the methods and propose further steps for overcoming them. We believe that the proposed method for assessing the collocational skill of Russian L2 writers can be successfully integrated into a bigger system capable of multifaceted automatic assessment of Russian learner texts.
Submerged ultrasonic welding of fused filament fabricated short carbon-fibre-reinforced polyamide plates with energy directors
Authors: Bose Sandeep , Chelladurai Hussain Mohamed , Ponappa Kannaiyram
Published: September 2023

Ultrasonic welding (USW) is an extensively used joining technique employed in various industries such as automotive, aeronautics, packaging, and others, for joining thermoplastic and thermoplastic composites. The strength of USW can be further enhanced through preferential heating with the induction of energy directors (EDs). The present study investigates water-submerged ultrasonic welding (S-USW) using three different ED designs to join 20% short carbon fibre-reinforced polyamide, commonly referred to as CF/PA. This approach improves weld strength and mitigates material degradation caused by rapid heating, a common issue encountered during USW. The results indicate that the submerged ultrasonic welded (S-USWed) specimen with a semi-circular ED exhibits the highest weld strength, that is, 16.4 MPa compared to specimens welded via conventional USW technique using rectangular and triangular EDs achieving weld strength of 14.69 and 14.3 MPa.
Platformised possessions and relational labour
Authors: Denegri-Knott Janice , Jenkins Rebecca , Molesworth Mike , Grigore Georgiana
Published: September 2023

In this article, we focus on relational labour as a form of emotional labour associated with the use of platformised possessions, such as pins, messages, photos, videos and playlists hosted on digital platforms, to maintain relationships with friends and family. We argue that this ongoing effort is a type of consumer labour because it generates profitable engagements for digital platforms, which intentionally exploit negative emotions, namely, anxiety and guilt, associated with maintaining social connections. Drawing on 47 depth interviews with people living in the South of the UK, we identify the direct (communication via platforms) and indirect (information gathered via platforms to attain relational goals) relational work undertaken by consumers via their platformised possessions. We then consider the emotional experiences related to this work, demonstrating how such experiences differ from reports of possession work on material goods, while maintaining platform profits. Recognising that this work is the basis of much platform engagement, and hence profit, we further show how this effort becomes a form of unpaid labour. We thus contribute to the nascent literature on platformisation and emotion, to broader studies of possession work, and to critical marketing scholarship on consumer labour.
‘It is more than just education. It’s also a peace policy’: (Re)imagining the mission of the European Higher Education Area in the context of the Russian invasion of Ukraine
Authors: Kushnir Iryna
Published: September 2023

Following the launch of Russia’s full-scale invasion of Ukraine in February 2022, scholarship has not yet addressed the role of the European Higher Education Area (EHEA) in this context. This paper asks: What is the political role of the EHEA as an institution and the instrumentalisation of its higher education (HE) cooperation initiatives in the context of the invasion? To investigate this, the paper thematically analyses interviews with representatives from key HE stakeholders in three EHEA members – Germany, France and Italy, as well as key recent international communications related to the EHEA’s response to the war. The thematic analysis revealed two overarching themes leading us to consider that: (1) the EHEA has been regaining its lost significance through shaping and disseminating its response as an institution to the invasion of Ukraine; and (2) HE cooperation in the EHEA in the context of this war has been acquiring a new meaning. These themes lead us to conclude that the war has prompted the EHEA to re-establish its purpose, following the ebbing interest in standardising HE structures. Most importantly, the EHEA has begun to emerge as a platform for political cooperation beyond HE for the promotion of peace in the European region.
“Everybody’s talking about doing co-design, but to really truly genuinely authentically do it […] it’s bloody hard”: Radical openness in youth participatory action research
Authors: Luguetti Carla , Ryan Juliana , Eckersley Bill , Howard Amy , Craig Sarah , Brown Claire
Published: September 2023

Guided by the work of bell hooks, this study uses her concept of ‘radical openness’ as an innovation for multi-party facilitation teams negotiating different roles, positionalities and understandings of youth participatory action research (YPAR). We explore the challenges we negotiated as facilitators in YPAR as they materialised in weekly reflections. We write as a team of two project leaders, three researchers and a project manager. Data comprised recordings of collaborative meetings, weekly reflections and focus groups. Two themes captured the challenges that we experienced and reflexively negotiated. First, we uncovered our own biases and assumptions through critical reflection and dialogue between comrades. Second, as a facilitation team we were able to negotiate authenticity and accountability in relation to project governance and reporting. Radical openness enabled us to identify and mitigate power relations as a team, collectively deepening our consciousness and research praxis. We all proved willing to acknowledge what we each did not know and use our imaginations to see things from each other’s perspectives. Based on our experiences, we suggest that multi-party facilitation teams consider how radical openness can help to cultivate spaces of dialogue between comrades to disrupt hegemonic and colonised views in YPAR.
“If you’re not happy there, you’re never going to find what you want”: Examining the transfer choice process for swirlers
Authors: Buenaflor Shannon Hayes , Lukszo Casey Maliszewski , LaFave Allison
Published: September 2023

Recent research reveals that many students are “swirling,” or transferring more than one time, and not always vertically. This rise in swirlers suggests that some students choose transfer institutions that do not fit their needs. Yet, very little research examines the choices students make as they seek to transfer from one school to another, and there is even less information about the experience of adult learners who transfer multiple times. The purpose of this descriptive case study is to explore the experiences and transfer college decision process of students who have transferred multiple times. Through examining the narratives of five swirling students, most of whom are adult learners, we aim to provide recommendations on how institutions can better support the choice process of non-traditional students and adult learners.
The Introspective Patient Experience of Mistletoe Therapy in Cancer: A Qualitative Study
Authors: Mascher Annika , Pelzer Florian , Duncan Lorna Jane , Martin David Dominique , Baumgartner Stephan , Berger Bettina
Published: September 2023

Introduction:

The introspective experience of cancer patients using mistletoe therapy has received little scientific interest, although it is crucial for a holistic understanding of this therapy. This study contributes to patient-centered research and treatment by documenting the subjective experiences of individuals undergoing mistletoe therapy.

Methods:

In this qualitative, explorative study, 20 outpatients with a history of various cancer types were recruited from Arlesheim Hospital (Arlesheim, Switzerland). All patients received subcutaneous mistletoe therapy for at least 2 years (median 7.5 years). Data was collected through 2 semi-structured, in-depth interviews per patient. Qualitative content analysis was applied to examine the data. The individual experience of mistletoe therapy was analyzed in relation to 6 predefined levels of human experience: physical, vital, emotional, mental, spiritual and social. In addition, 3 further aspects, considered as cross-dimensional perspectives, emerged out of the material: warmth, immune strengthening, and general wellbeing.

Results:

Data analysis revealed considerable heterogeneity among patients’ experiences with mistletoe therapy. The importance of specific aspects became apparent, such as increased vitality to manage daily life, greater emotional and mental stability, warmth as a multidimensional phenomenon, feelings of safety and protection through mistletoe therapy, heightened self-awareness and improved self-care, as well as sensations of spiritual connectedness.

Conclusions:

Prior to this study it had not been shown that cancer patients using mistletoe therapy do have observations on different levels of experience. These results may lead to a deeper understanding of patients receiving mistletoe therapy, enabling them to be supported in a more holistic way both during mistletoe treatment and on their life path. Further investigations into the effects of mistletoe therapy on the emotional, mental, and spiritual level are warranted.
Dynamical Measurement of Team Resilience
Authors: Grimm David A.P. , Gorman Jamie C. , Cooke Nancy J. , Demir Mustafa , McNeese Nathan J.
Published: September 2023

Resilient teams overcome sudden, dynamic changes by enacting rapid, adaptive responses that maintain system effectiveness. We analyzed two experiments on human-autonomy teams (HATs) operating a simulated remotely piloted aircraft system (RPAS) and correlated dynamical measures of resilience with measures of team performance. Across both experiments, HATs experienced automation and autonomy failures, using a Wizard of Oz paradigm. Team performance was measured in multiple ways, using a mission-level performance score, a target processing efficiency score, a failure overcome score, and a ground truth resilience score. Novel dynamical systems metrics of resilience measured the timing of system reorganization in response to failures across RPAS layers, including vehicle, controls, communications layers, and the system overall. Time to achieve extreme values of reorganization and novelty of reorganization were consistently correlated with target processing efficiency and ground truth resilience across both studies. Correlations with mission-level performance and the overcome score were apparent but less consistent. Across both studies, teams displayed greater system reorganization during failures compared to routine task conditions. The second experiment revealed differential effects of team training focused on coordination coaching and trust calibration. These results inform the measurement and training of resilience in HATs using objective, real-time resilience analysis.
Treatment Decision-Making in Myocardial Infarction for People With Advanced Kidney Disease: Protocol for a Qualitative Study
Authors: Scott Jemima , Selman Lucy E. , Caskey Fergus J. , Johnson Thomas , Ben-Shlomo Yoav , Bailey Pippa K.
Published: September 2023

Background: People with chronic kidney disease (CKD) have significantly higher morbidity and mortality following myocardial infarction (MI) than the general population. Despite this, they are less likely to receive invasive management and guideline-directed medications than those without kidney disease. It is unclear why this treatment variation exists and whether or not it reflects equal and appropriate access to care for the high-risk CKD population. Aims: The aims are to (1) understand how management decisions following an MI are made for, and with, people with CKD, and (2) describe the experiences of people with CKD who have recently received MI care in England. Method: We will recruit 15–20 patients with CKD and previous MI, and 15–20 clinical staff who are involved in treatment decision-making, from 3–5 NHS hospital trusts in the UK. Purposive sampling will be used to ensure diversity in participants with respect to age, gender, ethnicity and, where relevant, profession or degree of kidney impairment. We will undertake semi-structured interviews following flexible topic guides developed for patients and clinical staff. Interviews will be audio-recorded and transcribed. Transcripts will be analysed using the six steps outlined in Braun and Clarke’s thematic analysis, within an interpretivist, constructionist approach. Analysis will be primarily inductive. We will label sections of text with codes to reflect semantic or latent meaning and cluster similar codes together to derive themes which we will define and name. We will produce a report comprising themes central to MI treatment decision-making in people with CKD, illustrated with examples of data and analytic commentary, and demonstrate where our research stands within the context of the literature and wider context.
Speed control of marine main thruster motor based on super-twisting sliding mode variable structure
Authors: Langtao Yan , Yiran Ren , Zhihui Jin , Jianfeng Zhang
Published: September 2023

In order to solve the problem of torque-ripple in the control system of ship main propulsion motor controlled by direct torque control, this paper proposes a super-twisting sliding mode calculation method based on the traditional sliding mode controller, and designs the corresponding controller according to this method. The method is verified by Matlab/Simulink simulation tool. In the simulation waveform, the estimated speed of the super-twisting sliding mode control is almost consistent with the actual speed of the main propulsion motor, and the estimated rotor position is almost consistent with the actual rotor position of the motor, with small error. It is proved that this method has good practicability and effective feasibility in ship electric propulsion system, and provides theoretical reference for the design of ship electric propulsion system.
Effect of laminate parameters on nonlinear dynamic characteristic of the composite rotor-bearing system with pedestal looseness
Authors: Yang Mo , Xuan Hao , Qin Tao , Wang Yikun , Zhou Yuebin , Zhang Wen
Published: September 2023

The nonlinear dynamics of the composite shaft rotor-bearing system are greatly affected by the orientation angle layer and its proportion of the ply, i.e., the ratio of the orientation angle layer in the laminate. This paper presents a nonlinear dynamic analysis of a composite rotor-bearing system with pedestal looseness that considers the nonlinear oil film force and the pedestal looseness. Nonlinear phenomena including periodic, quasi-periodic, and chaotic motions are analyzed. The analysis results indicate that the stiffness and damping coefficients of a composite shaft tube can be influenced strongly by the laminate parameters, which can in turn affect the instability speed of the rotor system. To enhance the oil film instability speed of the composite rotor system, it is essential to maximize the ratio of the small orientation angle layer or the ±45° layer. Additionally, increasing the ratio of the small orientation angle layers in the shaft tube leads to a higher rotational speed for loosening instability. The research results obtained in this paper have important theoretical value for the design of composite rotor-bearing systems.
Knowledge, attitudes, and practices of female health care service providers on female genital mutilation in Somalia: A cross-sectional study
Authors: Mehriban Nadira , Zafar Ullah Abu Naser , Haque Md Imdadul , Harun Md Golam Dostogir , Isse Deka Mohamed , Muhammad Faisal , Chowdhury ABM Alauddin , Chowdhury Moniruddin , Hasan Md Zobaer , Dessoffy Thomas
Published: September 2023

Background:

Despite a strong international standpoint against female genital mutilation, the prevalence of female genital mutilation in Somalia is extremely high.

Objectives:

This study assessed the knowledge, attitude, and practice of female genital mutilation among female health care service providers in order to formulate appropriate policies and programs to eliminate this harmful practice.

Design:

Facility-based cross-sectional survey conducted in 2019 among female doctors and nurses working in Banadir Hospital, Mogadishu, Somalia.

Methods:

A total of 144 female health care service providers were randomly selected, and data were collected through a pre-tested, semi-structured questionnaire. Quantitative data were analyzed by using the statistical software SPSS (Version 21), and qualitative data were analyzed thematically in accordance with the objectives of the study.

Results:

The study found that about three-fifths of the respondents had undergone some forms of female genital mutilation during their life. An overwhelming majority believed that female genital mutilation practices were medically harmful, and a majority of them expressed their opinion against the medicalization of the practice of female genital mutilation. The study also observed a significant association between participants’ age and their negative attitudes regarding the legalization of female genital mutilation.

Conclusion:

Health care service providers’ effort is critical to eliminating this harmful practice from the Somalian society. Strong policy commitment and a comprehensive health-promotion effort targeting the parents and community leaders are essential to avert the negative impact of female genital mutilation.
Safety and efficacy of tenecteplase versus alteplase in stroke patients with carotid tandem lesions: Results from the AcT trial
Authors: Bala Fouzi , Almekhlafi Mohammed , Singh Nishita , Alhabli Ibrahim , Ademola Ayoola , Coutts Shelagh B , Deschaintre Yan , Khosravani Houman , Appireddy Ramana , Moreau Francois , Phillips Stephen , Gubitz Gord , Tkach Aleksander , Catanese Luciana , Dowlatshahi Dar , Medvedev George , Mandzia Jennifer , Pikula Aleksandra , Shankar Jay , Williams Heather , Field Thalia S , Manosalva Alejandro , Siddiqui Muzaffar , Zafar Atif , Imoukhoude Oje , Hunter Gary , Benali Faysal , Horn MacKenzie , Hill Michael D , Shamy Michel , Sajobi Tolulope T , Buck Brian H , Swartz Richard H , Menon Bijoy K , Poppe Alexandre Y
Published: September 2023

Background:

Carotid tandem lesions ((TL) ⩾70% stenosis or occlusion) account for 15–20% of acute stroke with large vessel occlusion.

Aims:

We investigated the safety and efficacy of intravenous tenecteplase (0.25 mg/kg) versus intravenous alteplase (0.9 mg/kg) in patients with carotid TL.

Methods:

This is a substudy of the alteplase compared with the tenecteplase trial. Patients with ⩾70% stenosis of the extracranial internal carotid artery (ICA) and concomitant occlusion of the intracranial ICA, M1 or M2 segments of the middle cerebral artery on baseline computed tomography angiography (CTA) were included. Primary outcome was 90-day-modified Rankin Scale (mRS) 0–1. Secondary outcomes were mRS 0–2, mortality, and symptomatic ICH (sICH). Angiographic outcomes were successful recanalization (revised Arterial Occlusive Lesion (rAOL) 2b–3) on first and successful reperfusion (eTICI 2b–3) on final angiographic acquisitions. Multivariable mixed-effects logistic regression was performed.

Results:

Among 1577 alteplase versus tenecteplase randomized controlled trial (AcT) patients, 128 (18.8%) had carotid TL. Of these, 93 (72.7%) underwent intravenous thrombolysis plus endovascular thrombectomy (IVT + EVT), while 35 (27.3%) were treated with IVT alone. In the IVT + EVT group, tenecteplase was associated with higher odds of 90-day-mRS 0–1 (46.0% vs. 32.6%, adjusted OR (aOR) 3.21; 95% CI = 1.06–9.71) compared with alteplase. No statistically significant differences in rates of mRS 0–2 (aOR 1.53; 95% CI = 0.51–4.55), initial rAOL 2b–3 (16.3% vs. 28.6%), final eTICI 2b–3 (83.7% vs. 85.7%), and mortality (18.0% vs. 16.3%) were found. SICH only occurred in one patient. There were no differences in outcomes between thrombolytic agents in the IVT-only group.

Conclusion:

In patients with carotid TL treated with EVT, intravenous tenecteplase may be associated with similar or better clinical outcomes, similar angiographic reperfusion rates, and safety outcomes as compared with alteplase.
Safety and efficacy with alemtuzumab over 13 years in relapsing-remitting multiple sclerosis: final results from the open-label TOPAZ study
Authors: Coles Alasdair J. , Achiron Anat , Traboulsee Anthony , Singer Barry A. , Pozzilli Carlo , Oreja-Guevara Celia , Giovannoni Gavin , Comi Giancarlo , Freedman Mark S. , Ziemssen Tjalf , Shiota Debora , Rawlings Andreea M. , Wong Alana T. , Chirieac Magdalena , Montalban Xavier
Published: September 2023

Background and objectives:

Alemtuzumab demonstrated superior efficacy versus subcutaneous interferon (IFN) beta-1a in participants with relapsing-remitting multiple sclerosis in the 2-year CARE-MS I and II trials. Efficacy was maintained in the 4-year CARE-MS extension, during which alemtuzumab-treated participants (‘alemtuzumab-only’) could receive additional courses upon disease activity, and IFN-treated participants switched to alemtuzumab (‘IFN-alemtuzumab’). Participants who completed the CARE-MS extension could enroll in the open-label TOPAZ study which assessed safety and efficacy for 5–7 years (11–13 years after alemtuzumab/IFN initiation).

Methods:

Participants received additional alemtuzumab courses as needed. Assessments included adverse events (AEs; primary outcome), annualized relapse rate (ARR), 6-month confirmed disability worsening [CDW; ⩾1.0-point Expanded Disability Status Scale (EDSS) score increase or ⩾1.5 if baseline EDSS = 0], and 6-month confirmed disease improvement [CDI; >1.0-point EDSS decrease (baseline score ⩾2.0)].

Results:

43.5% of alemtuzumab-only participants from CARE-MS II and 54.2% from CARE-MS I received no additional alemtuzumab courses; 30.0% and 20.9%, respectively, received one additional course (the median). Incidences of AEs, including thyroid AEs and infections, declined over time. The safety profile of alemtuzumab was similar for participants who received zero, one, or two additional courses. For CARE-MS II participants, who had inadequate response to previous treatment, ARR remained low during Years 3–13 for the alemtuzumab-only [0.17; 95% confidence interval (CI) 0.15–0.20] and IFN-alemtuzumab (0.14; 0.11–0.17) groups. At Year 11, the proportions of participants who were either free from CDW or who had CDI were higher in the alemtuzumab-only group (58% and 49%, respectively) than in the IFN-alemtuzumab group (51% and 37%). For CARE-MS I participants, who were previously treatment-naïve, clinical outcomes remained improved, and no between-group differences were apparent.

Conclusion:

Safety risks associated with alemtuzumab treatment declined over time. Clinical benefits were maintained up to 11–13 years, and most participants did not require more than one additional course.

Clinicaltrials.gov identifiers:

NCT00530348; NCT00548405; NCT00930553; NCT02255656
Role of immunotherapy in chondrosarcoma: A case report and review of the literature
Authors: Cohen-Nowak Adam J. , Dressler Danielle B. , Rock Adam , Mojica Katherine , Woo Doni , Zuckerman Lee M. , Chow Warren , Agulnik Mark
Published: September 2023

Chondrosarcomas (CSs) consist of a heterogenous group of primary bone cancers arising from malignant cells which produce cartilaginous matrix. As the second most common primary bone cancer, CS are often resistant to systemic chemotherapy due to poor vascularization, slow proliferation, and expression of multidrug-resistant pumps. Immune checkpoint inhibitors have transformed the field of oncology and are now designated as frontline therapy for many solid tumor cancers. Several studies have demonstrated increased expression of programed cell death 1 (PD-1) and PD-L1 in CS tissue in vitro, which has led to the development of multiple clinical trials for immunotherapy in patients with aggressive CS. In this review, we highlight the ongoing investigation into the role for immunotherapy in CS. We also report the case of a 44-year-old female with a history of stage IV primary CS of the right shoulder who underwent radical resection with recurrence and demonstrated a spectacular sustained response to pembrolizumab at our center. Our review highlights the need for further studies investigating the role of immunotherapy in the treatment of aggressive bone sarcomas that are resistant to standard surgical resection, chemotherapy, and radiation treatment.
The Associations Between Wellbeing and Injury Differ by Time Loss in Collegiate Athletes
Authors: Sanfilippo Jennifer L. , Hoffmann Courtney N. , Haraldsdottir Kristin , Steiner Quinn , Watson Andrew M.
Published: September 2023

Background:

Self-reported wellbeing measures such as mood and soreness have been identified as predictors of injury risk. However, most research has focused on investigating time-loss injuries even though nontime-loss injuries are more prevalent.

Hypothesis:

Impairments in sleep and subjective wellbeing would be associated with increased injury for both time-loss and nontime-loss injuries.

Study Design:

Prospective longitudinal study.

Level of Evidence:

Level 3.

Methods:

During 2022, 127 athletes completed a daily survey that inquired about training load and sleep from the previous day along with mood, stress, and soreness on the current day. Incidence of injury was also monitored using documentation provided by athletes’ respective athletic trainers. Mixed effect models were used to analyze the relationship between wellbeing and sleep measures with injury.

Results:

Self-reported wellbeing, based most closely on soreness the day of injury, by National Collegiate Athletic Association Division 1 collegiate athletes was predictive of time-loss injuries, whereas no significant relationship was identified for nontime-loss injuries. Specifically, 1 unit increase in soreness was associated with a 39% increase in odds of sustaining a time-loss injury.

Conclusion:

This study found that subjective wellbeing and sleep have a different relationship with injury dependent upon whether the resulting injury leads to time loss.

Clinical Relevance:

Self-reported wellbeing appears to be a relevant predictor of injury among collegiate athletes for time-loss injuries.
The employment implications and tax status of English football referees: Commissioners for HM Revenue and Customs v Professional Game Match Officials Ltd [2021] EWCA Civ 1370
Authors: McArdle David
Published: September 2023

In September 2021, the Court of Appeal in England and Wales delivered its judgment in the case of Commissioners for HM Revenue and Customs v Professional Game Match Officials [2021] EWCA Civ 1370 (hereafter PGMOL). The case concerned the employment status of referees who officiate in the men's professional game. The First-Tier Tribunal of the Tax and Chancery Chamber (FTT) had allowed PGMOL's appeal against the Revenue's determination that a certain class of part-time referees were the employees of PGMOL under s. 4(1) of the Income Tax (Earnings and Pensions) Act 2003, and that income tax and employer's national insurance contributions should be deducted from the payments that PGMOL made to them in 2013–2016. On the Revenue's appeal, the Upper Tribunal (UT) upheld the FTT's decision on 6 May 2020. The Revenue further appealed.
Layout considerations on compound survival shelters for blast mitigation: A finite-element approach
Authors: Caçoilo Andreia , Mourão Rodrigo , Lecompte David , Teixeira-Dias Filipe
Published: September 2023

The safety of both military personnel and equipment in unstable regions has for a long time been a major issue and concern. Protective shelters with multiple configurations have been widely used to meet safety requirements. Since military compounds are subjected to different types of threats, such as the detonation of improvised explosive devices (IED), a good understanding of the response of such shielding structures to blast waves is critical. A three-dimensional finite element (FE) model of a corner-entry ISO 20 ft container HESCO-Bastion survival shelter is developed, validated and tested under the external detonation of explosive charges. The FE model is validated against experimental data and used to investigate the protective performance of the shelter by considering several design-related parameters, such as charge location, roof extension, interior corridor dimensions and the effect of venting and its location. Results are discussed in terms of peak overpressure and maximum impulse at discrete locations around the container, and it is found that the shelter is the least efficient in mitigating the blast load propagation when the explosive material is at an angle of 45° to the entrance. Also, while the protective roof at the entrance plays a significant role in protecting the container from air-borne threats, it is observed that it contributes to higher pressure and impulse data within the shelter, for detonations at ground level, with impulse amplifications as high as 94% when fully covering the entrance area. Contrarily, varying the distance between the container and the HESCO-Bastions is found to have minimal impact on the impulse, while naturally decreasing the peak pressure for increasing distances. Venting (through openings) can lead to up to 95% reduction in the peak pressure, whilst not affecting the impulse.
Is post-traumatic stress disorder a risk factor for development of opioid use disorder among individuals with chronic non-cancer pain? A systematic review
Authors: Kendurkar Arvind , Wilson Jack , Sunderland Matthew , Dunlop Adrian , Hayes Chris , Marel Christina , Mills Katherine L
Published: September 2023

Introduction

There is emerging evidence that posttraumatic-stress disorder may have mediating effects in development of chronic-non-cancer-pain and opioid-use-disorder independently, but its impact on the development of opioid-use-disorder in people with chronic-non-cancer pain is still unclear.

Objectives

(i) Estimate the risk of opioid-use-disorder among individuals with chronic-non-cancer-pain and posttraumatic-stress disorder, relative to those with chronic-non-cancer-pain only, and (ii) identify potential correlates of opioid-use-disorder among people with chronic-non-cancer-pain and posttraumatic-stress disorder.

Methods

This systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Longitudinal, epidemiological, cohort, follow-up, retrospective, prospective and cross-sectional studies reporting measures of variance on the likelihood of developing opioid-use-disorder with posttraumatic-stress disorder among individuals with chronic-non-cancer-pain were identified from six-electronic databases (Medline, Embase, Evidence-based Medicine reviews, PsycINFO, Scopus and Web of Science) until December 2022.

Results

Three out of the four studies, which met the selection criteria for this analysis reported statistically significant positive association between risk of developing opioid-use-disorder with posttraumatic-stress disorder among chronic-non-cancer-pain cohort (unadjusted Relative-Risk range: 1.51–5.27) but this association was not evident in the fourth study (adjusted Relative-Risk: 0.96; statistically non-significant), when adjusted for sociodemographic variables. The increased risk was noted particularly with females and chronic musculoskeletal pain conditions.

Conclusions

Posttraumatic-stress disorder can increase the risk of development of opioid-use-disorder among people with chronic-non-cancer-pain and a better understanding of this relationship will help to predict and prevent the development of opioid-use-disorder and may also help in reducing the disability and burden associated with chronic-non-cancer-pain.

Perspective

This review quantifies the risk of developing opioid-use-disorder in the context of posttraumatic-stress disorder among individuals with chronic-non-cancer-pain. Awareness and subsequent practice change will reduce the increasing global burden associated with the chronic-non-cancer-pain.
How cyberchondria and decision self-efficacy shapes the acceptability of COVID-19 vaccine: A gender-based comparison
Authors: Shahani Riffat , Asmi Fahad , Ma Jin , Zawar Asma , Rufai Olayemi Hafeez , Muhideen Sayibu , Amosun Tunde Simeon , Jianxun Chu
Published: September 2023

Objective

Alarmingly, the individuals’ reach and coverage to get vaccinated in developing regions during the pandemic is a massive challenge for concerned authorities. This study aimed to demonstrate how cyberchondria play a significant role in a classical health belief model. Cyberchondria may influence cognitive factors (e.g. self-efficacy), which may contribute to an increase in attitude–behavior gap. Especially in the context of a health-centric scenario, it may discourage individuals to take protective measures.

Method

By using the cross-sectional research design, the authors conducted a quantitative survey in Pakistan and collected 563 responses from 303 male respondents (rural = 91; urban = 212) with (Urban M:35.5, standard deviation (SD):13.4) and rural M:37.5, SD:8.4).

Result

The findings indicate that decision self-efficacy among males is stronger than that in females. It dominates other determinants, which can dampen the individuals’ intentions to get vaccinated. For instance, the effect of conspiracies and perceived seriousness was noted nonsignificant and weak. In females, perceived seriousness was stronger determinant than in males. In addition, the negative effect of decision self-efficacy was noted in the case of females, and conspiracy and cyberchondria had a negative role.

Conclusion

This study highlights valuable implications for future research in infodemic, health communication and health literacy, and practical implications for regulatory bodies and public administration.
Software-related challenges in Swedish healthcare through the lens of incident reports: A desktop study
Authors: Rahman Jabin Md Shafiqur , Pan Ding
Published: September 2023

Objective

To identify a subset of software issues occurring in daily Swedish healthcare practice and devise a set of local solutions to overcome the challenges.

Methods

A sample of 46 incident reports was collected from one of Sweden's national incident reporting repositories, ranging from June 2019 to December 2021. The reports were first subjected to an algorithm to identify if they were health information technology-related incidents and were analysed using an existing framework, i.e., the Health Information Technology Classification System, to identify the software-related incidents. The incidents associated with software issues were then subjected to thematic analysis, in which themes were extracted and presented under the category assigned by the existing framework used.

Results

Of 46 reports, 45 (with one exception) were included using the algorithm. Of 45 incidents, 31 software-related incidents were identified using the classification system. Six types of software issues were identified, including software functionality ( n = 10), interface with other software systems or components ( n = 10), system configuration ( n = 7), interface with devices ( n = 2), record migration ( n = 1) and increased volume of transactions ( n = 1). Each issue was further categorised into different themes; for example, software interface-related problems were grouped into ‘two patients being active in the system simultaneously’ ( n = 6) and ‘transfer of patient information’ ( n = 4).

Conclusions

The study provided some insights into software issues and relevant consequences. A set of local solutions were devised to overcome the present challenges encountered in Swedish healthcare in their daily clinical practice. Systematic identification and characterisation of such software challenges should be a routine part of clinical practice for all major health information technology implementations.
Effects of computer-based cognitive training combined with physical training for older adults with cognitive impairment: A four-arm randomized controlled trial
Authors: Chuang I-Ching , Chiau Hui-Yan , Liao Wan-Wen , Wu Yih-Ru , Chang Chih-Hung , Wu Ching-Yi
Published: September 2023

Objective

Combined physical (PHY) and cognitive (COG) training in sequential (SEQ) and simultaneous (SIMUL) sessions may delay the progression of cognitive impairment. To date, no study has directly compared in older adults with cognitive impairment the effects of COG training, PHY training, SEQ motor-cognitive training and SIMUL motor-cognitve training on specific indices of cognitive performance and activities of daily living (ADL). The purpose of this study was to determine whether SEQ and SIMUL motor-cognitive training can improve treatment outcomes compared with PHY or COG training alone. We also aimed to compare the effects of SEQ versus SIMUL motor-cognitive training on cognitive functions and instrumental ADL (IADL) in older adults with cognitive impairment.

Methods

A cluster randomized controlled trial was conducted. Eighty older adults with cognitive impairment were randomly assigned to COG, PHY, SEQ or SIMUL training groups. The intervention consisted of 90-min training sessions, totaling 36 sessions. Outcome measures were the Montreal Cognitive Assessment, three subtests of the Wechsler Memory Scale (WMS) and the Lawton IADL scale.

Results

Significant interaction effects between group and time were found in WMS-spatial span ( p = 0.04) and WMS-word lists ( p = 0.041). For WMS-spatial span, the SIMUL group showed outperformed the COG ( p = 0.039), PHY ( p = 0.010) and SEQ groups ( p = 0.017). For WMS-word lists, the SEQ group improve more than COG ( p = 0.013), PHY ( p = 0.030) and SIMUL ( p = 0.019) groups. No significant differences were found in IADL performance among four groups ( p = 0.645).

Conclusions

Our study showed SEQ and SIMUL motor-cognitive training led to more pronounced improvements in visuospatial working memory or verbal memory compared with isolated COG or PHY training for community-based older adults with cognitive impairment. For enhancing effects on IADL, we suggest the use of sensitive measurement tools and context-enriched cognitive training involving real-life task demands.
Systemic evaluation of the relationship between asthma and osteoarthritis: Evidence from a meta-analysis and Mendelian randomization study
Authors: Nie Yaoyao , Liu Houpu , Wang Jing , Yang Ye , Zhao Wenxia , Chen Dingwan , Li Yingjun
Published: September 2023

Objective

Osteoarthritis (OA) and asthma are two common chronic diseases with increasing incidence and prevalence, whereas there has been rare evidence to suggest the relationship between OA and asthma. This study aimed to analyze the causal relationship between OA and asthma.

Methods

Existing studies of the relationship between asthma and OA published till July 18, 2023, were identified from PubMed and Web of Science databases for meta-analysis. Subsequently, the causal relationship of all and site-specific OA with asthma was explored through a bidirectional two-sample Mendelian randomization (MR) analysis.

Results

A total of four eligible studies were included in the meta-analysis. In these studies, 80,550 participants were recruited, of whom 13,781 patients had OA. The asthma group had a significantly higher prevalence of OA than the control group (odds ratio (OR) = 2.08; 95% confidence intervals (CI): 1.42–3.03). However, MR analysis did not support a causal relationship between asthma and all OA and site-specific OA: knee and hip OA (OR = 1.03; 95% CI: 0.98–1.09), knee OA (OR = 1.02; 95% CI:0.96–1.08), and hip OA (OR = 1.04; 95% CI: 0.97–1.12). No causal relationship between OA and asthma was found through reverse MR analysis.

Conclusions

This meta-analysis suggests that patients with asthma are likely to have a greater prevalence of OA. However, the result of MR analysis reveals that asthma does not have a causal relationship to all OA or site-specific OA.
An electronic health record system implementation in a resource limited country—lessons learned
Authors: Ali Sayed K , Khan Haroon , Shah Jasmit , Nadeem Ahmed K
Published: September 2023

Electronic health records have revolutionized the medical world by improving medical care, refining provider documentation, standardizing care, and minimizing sentinel events. Successful implementation of electronic health records remains a daunting task and requires careful strategic planning and buy-in from key stakeholders. Much has been published in resource-rich settings and high-income countries about implementations of electronic health records. However, little is known about the experience in resource-limited settings where challenges remain unique and distinct from other parts of the world. Our intention is to share lessons learned during implementation of a web-based electronic health record at a tertiary care center in Kenya.