bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer Worry and Fatalism at the Intersection of Race and Hearing Status
Authors: Perrodin-Njoku Emmanuel C. , Rao Sowmya R , Moreland Christopher J , Wang Regina M , Kushalnagar Poorna
Published: October 2024

Introduction

The deaf and hard of hearing (DHH) community experiences lower cancer screening rates than the general population. Cancer worry and fatalism can influence cancer screening, along with race, and the interaction of intrinsic factors with DHH health behavior needs to be investigated.

Objectives

The study examines the association of the intersection of race and hearing status with cancer worry and fatalism.

Methods

This study analyzed cross-sectional survey data from NCI HINTS-ASL (for DHH adults) and NCI HINTS (for hearing adults). Multivariable logistic regression models were used to assess (i) the association of race-hearing status intersection with cancer worry and fatalism, as well as (ii) the relationship between hearing status and outcomes within each race.

Results

The study found that the overall interaction between race and hearing status was significantly associated with both high cancer worry and fatalism, with African American (AA)/Black and Asian/Other having higher odds of worry [1.17 (0.83, 1.64); 1.19 (0.85, 1.66), respectively] and other groups having lower worry than White hearing ( P < 0.0001), and all deaf having less concern about cancer fatalism ( P < 0.0001). Within each racial group, White DHH respondents had lower odds of cancer worry [aOR (95% CI): 0.72 (0.58, 0.91); P < 0.01] and fatalism [0.55 (0.46, 0.67); P < 0.0001] compared to White hearing respondents, while DHH AA/Black [1.89 (1.06, 3.37); P = 0.03], Asian/Other [2.39 (1.06, 3.37); P = 0.03], and Hispanic [1.95 (1.18, 3.22); P < 0.01] respondents had significantly higher odds of cancer worry and lower odds of cancer fatalism [Black: 0.50 (0.23, 1.09); P = 0.07; Asian/Other: [0.68 (0.42, 1.09); P = 0.10]; Hispanic: [0.69 (0.40, 1.17)]; P = 0.16] compared to their hearing counterparts.

Conclusion

DHH individuals have different odds of experiencing cancer worry and fatalism compared to their hearing counterparts. Inclusion of individuals with sensory disabilities in a larger cancer study sample enriches the diversity of perspectives, ensuring that the findings reflect a broader range of experiences and needs. More research into contributory factors in the signing DHH population is needed.
Dialogue With Indigenous Women’s Historical Memory Requires Epistemic Openings
Authors: Paredes Julieta , Silva Guimarães Danilo
Published: October 2024

Indigenous people of today’s generations have placed our truths, questions, and answers in the space-time of the contemporary world in which we live and in which we want to realize a vital principle of our cultures. The historical memory of the indigenous women of Abya Yala is approached in this work as an experience conditioned by contemporaneity and by the needs that the indigenous women of Abya Yala have today to understand the historical processes of the indigenous peoples of this region. We discuss the forgetting of the historical memory of the indigenous women of Abya Yala, a socially produced and individually sustained forgetting in our territories, which have suffered colonial invasion since 1492. Among the various fundamental authors in this historical process that gave rise to modern psychology, we have selected some reflections by Wilhelm Dilthey, focusing the responsibility given by historical consciousness. A consciousness that is formed on the basis of extracting what is important from the past and making sense of it for the collective being. This paper does not exhaust the totality of the phenomena involved because it is based on the present elaboration of a historical phenomenon.
Cranial Defect Repair With 3D Designed Models
Authors: Dabadi Sambardhan , Dhungel Raju Raj
Published: October 2024

Cranioplasty is one of the most common neurosurgical procedure performed to repair cranial defect. Many materials and fabrication technique are used to prepare cranial implant in cases where autologous bone is not available. Polymethyl Methacrylate (PMMA) is one of the most common polymer used as bone substitute. PMMA fabricated using 3D printed models have shown better fit, symmetrical shape, and restore esthetic looks of patients. The use of 3D printed implants in medical procedures has several advantages over traditional manufacturing methods. 3D printing allows for greater precision, customization, and quicker implant time.
Ill persons and capable workers: Constructing work ability in return-to-work negotiations after sickness absence
Authors: Keränen Hanna , Tiitinen Sanni , Juvonen-Posti Pirjo , Weiste Elina , Seppänen Soile , Ala-Mursula Leena
Published: October 2024

In return-to-work (RTW) negotiations after sickness absence, the work ability of an individual employee becomes a shared interest for the multiple stakeholders representing both the healthcare sector and working life. In practice, the employee, employer and occupational health professionals need to reach a shared understanding of the employee’s work ability to enable shared decision-making concerning the plans for sustainable RTW. Drawing on 14 video-recorded RTW negotiations, we used conversation analysis-informed membership categorization analysis to examine how the participants of RTW negotiations discuss the work ability of an employee to pursue a shared understanding of the situation. Work ability was constructed in a very situational way, using illness categories to both explain the work ability of the employee and argue for or against their ability or inability to work. Our study contributes to research on RTW by introducing a new perspective to work ability. We show how work ability is realized during RTW negotiations through interaction, and how participants leverage their cultural understanding of illness and capability when negotiating work ability. We also demonstrate how membership categorization analysis can reveal the situational and consequential aspects of illness and work ability categories.
Telemedicine and patient-centered care: The perspective of primary-care physicians
Authors: Keshet Yael , Popper-Giveon Ariela , Adar Tamar
Published: October 2024

Patient-centered care (PCC) has become a central aim for healthcare systems worldwide due to recognition of its advantages. The growing use of telemedicine technologies (TT) raises concerns of diminishing interpersonal contact, especially in primary care, and questions the appropriate way of implementing PCC. This article aims to explore primary-care physicians’ (PCP) experiences of PCC when using TT. During 2023 in-depth interviews were conducted with 20 Israeli PCP: family physicians and pediatricians. The PCP described their experiences of using TT in their communication with patients as including some characteristics of PCC but not others. They related to TT as a means of forming relationships and communicating with patients, highlighting its individualistic focus and describing it as a way of coordinating care. When describing the use of TT in their communication with patients, they barely related to empathy and respect for the patient, to their own involvement in the treatment, to shared decision-making, or to a holistic focus on the patient. The absence of interpersonal qualities and soft skills communication from the physicians’ TT experience seems to erode their personal well-being and professional satisfaction and may even lead to burnout. We therefore recommend instructing PCP to better integrate PCC into their TT communication with patients since it contributes to the quality of healthcare and is significant for the well-being of both patients and physicians.
Numerical simulation of anti-shatter films (ASF) for mechanical post-breakage analysis of retrofitted glass
Authors: Mattei Silvana , Cozzarini Luca , Bedon Chiara
Published: October 2024

Post-breakage strength and residual mechanical capacity improvements are important tasks for load-bearing structural components in general, and even more for glass elements, in order to protect people from injury in case of breakage. For this reason, among others, the design of glass components and structures is based on key concepts that are generally summarized in structural safety, robustness and redundancy. With regard to the last fundamental requirement, nowadays the use of laminated glass (LG) sections is spread for many applications and new projects, such as automotive or aircraft windshields, but especially curtain walls and many other load-bearing applications in buildings. This strategy derives from the intrinsic safety and security levels of LG sections after possible glass breakage. When LGs are not available (i.e., existing components), anti-shatter safety films (ASF) for the retrofit of monolithic glass elements are expected to provide very similar post-breakage structural performances against bending and impact actions, by reducing the possible spread of glass shards. Besides, the residual load-bearing capacity of glass components retrofitted by ASF is still challenging to quantify. In this paper, the Cohesive Zone Model (CZM) theory is considered to investigate, with the support of experiments and Finite Element (FE) numerical models, the performance of small-scale monolithic glass specimens retrofitted by ASF under bending loads. Different ageing procedures and imposed displacement-rates are considered to evaluate the influence of basic operational parameters, such as temperature and humidity, on the mechanical efficiency of common ASF layers. In doing so, the sensitivity of fundamental input parameters (i.e., maximum tensile strength of glass and fracture energy of the ASF adhesive) on the mechanical performance at pre- and post-breakage stages of retrofitted monolithic glass elements is explored.
Field test of internal visualization of deep-water pile foundation using ultrasonic waves
Authors: Wang Zijian , Peng Zhangkai , Yan Yuwei , Liu Kangzhao , Wu Zhishen
Published: October 2024

Early-age internal visualization is critical for timely assessing the quality of pile foundations, especially as super cross-sea bridges increase the diameter and length of pile foundations beyond the capabilities of traditional cross-hole sonic logging (CSL). This article introduces two innovations. First, ultrasonic instruments are specially developed to transmit waves through a concrete pile with a diameter of 4 m, a length of 92 m, and a water depth of 63 m, before the full hardening of concrete. Second, an imaging method is proposed to upgrade traditional CSL from 1D detection to 3D visualization. Both large-scale experiments and field tests are tested in the first 7 days after the concrete casting. The experiments successfully visualize typical construction defects, achieving a detection resolution of 18 cm for layered defects and 15 cm for void defects. During the field test, a low-pixel region is observed at the pile head, extending approximately 2.1 m deep, attributed to mud floating up during concrete casting into the steel casing. These developments in instrument technology and visualization methods provide essential tools for the quality evaluation of super pile foundations. Furthermore, the visualization data can support digital twin modeling in subsequent stages of construction and maintenance planning.
The Reign of Racialized Residential Sorting: Gentrification and Residential Mobility in the Twenty-First Century
Authors: Hwang Jackelyn , Zhang Iris H.
Published: October 2024

Despite recent theoretical advances in explaining the persistence of segregation in the United States through structural sorting processes, how the spread and intensification of gentrification intersects with these processes is less clear. Drawing on the 2000–2017 waves of the Panel Study of Income Dynamics (PSID) and fixed effects logistic and linear regression models, we examine gentrification’s relationship with residential mobility patterns and whether this relationship is racially stratified. We do not find evidence that living in gentrifying neighborhoods is associated with higher rates of moving for lower-income respondents compared to those living in nongentrifying neighborhoods nor does this differ by race. However, we find starkly different locational outcomes between Black and White movers across the income spectrum, rather than the gentrification status of one’s neighborhood. We argue that processes of racial stratification in the housing market largely govern residential outcomes, regardless of gentrification.
Endovascular Treatment of Complex Aorto-Iliac Atherosclerotic Occlusive Disease With Chimney Covered Endovascular Reconstruction of Aortic Bifurcation
Authors: Dvir May , Shuja Fahad , Sen Indrani , Gurrieri Carmelina , Carmody Thomas , Tallarita Tiziano
Published: October 2024

Treatment of atherosclerotic occlusive disease of the infrarenal aorta poses several challenges. Traditionally, open surgery has been the preferred method of treatment in standard risk patients, although, it is burdened by high morbidity and mortality. There are many classifications to establish the patient risk for surgery. Among the most common is the American College of Cardiology (ACC)/American Heart Association (AHA) classification. ACC/AHA high-risk patients benefit from the increase in endovascular technology and skills. The treatment modality of atherosclerotic aortic disease has shifted towards a minimally invasive approach, including kissing stents, covered endovascular reconstruction of the aortic bifurcation (CERAB) and, aorto-uniiliac stent grafts. When there is an involvement of vital branches such as the inferior mesenteric (with concomitant occluded superior mesenteric artery) or the renal arteries, Chimney- CERAB technique has been successfully utilized to overcome this challenge. We present three patients with aortoiliac occlusive disease (AIOD) successfully treated with the chimney- CERAB technique to preserve a large inferior mesenteric artery in the setting of occlusion/near occlusion of the other mesenteric vessels.
A comprehensive ergonomic validation of workspaces design employing digital and physical mock-ups in the case of light armored vehicle
Authors: Wibneh Amare , Singh Ashish Kumar , Karmakar Sougata
Published: October 2024

The study aims to evaluate the compatibility of the proposed design workspace dimensions of light armored vehicle (LAV) with the targeted populations of Ethiopian army personnel using both digital and physical ergonomic evaluations. The dimensional compatibility was tested using digital mock-up interfaced with human manikin representing the anthropometries of 5th percentile female and 95th percentile male values for Ethiopian army. CATIA V5 software was utilized for developing digital human and vehicle models, while the physical mock-up was tested through minimum possible user trials (to avoid redundancy of testing) that involved 13 users sufficient to represent the target population. The intended vehicular workspaces, in terms of space adequacy, view field, reaching, and manipulative needs were found to be ideally compatible with the target users, accommodating 90% (for adjustable units) and 95% (for non-adjustable units) of them. This confirms that the proposed basic design dimensions of LAV workspaces for driver, gunner, commander, and other infantry troops are compatible with the target users in both evaluation techniques. Hence, our findings indicate that the newly proposed design dimensions can be utilized as design standards primarily for fabricating Ethiopian LAVs, as they ensure occupational compatibility for the users, which can improve crew operational performance, efficiency, and safety.
Numerical and experimental analysis of structural optimization and flow resistance effect of safety barrier based on a pump device
Authors: Luan Yi , Yang Fan , Jiang Dongjin , Wang Bao , Xu Guiying , Wang Zhenghua , Nasr Ahmed
Published: October 2024

The safety barrier is often positioned at the entrance of the inlet passage in large and medium-sized low-lift pump stations, to ensure the safety of people and animals. To elucidate the blocking effect of the safety barrier and its influence mechanism on the internal flow of the inlet passage, numerical simulation combined with the physical model test were employed to investigate the impact of the cross-section and bar spacing of the safety barrier on the head loss, and the impact mechanism was clarified. The results showed that the optimal cross-section form of the safety barrier was found to be circular from the standpoint of head loss. When the blockage ratio of the safety barrier exceeds 0.3; prompt clearance of the blockage is recommended.
Extracranial internal carotid artery aneurysm: Surgical approach to a rare entity
Authors: Oztas Didem Melis , Cobanoglu Seckin , Cakir Asli , Kuguoglu Okan , Oteyaka Emre , Ugurlucan Murat
Published: October 2024

Background

Extracranial internal carotid artery aneurysms are rare entities that arise within the carotid triangle. Although rare, they are clinically significant due to the risk of neurologic thromboembolic events, compression of cranial nerves and vasculature, rupture, and ischemia.

Objective

Surgery is the gold-standard treatment for symptomatic patients of all ages with extracranial internal carotid artery aneurysm.

Method

A 26-year-old female patient was admitted to our institution with complaints of left auricular pain, hoarseness, and uncontrollable hypertension. She had a pulsatile mass located at the left cervical region. After diagnosing the extracranial internal carotid artery aneurysm, it was decided that surgery was necessary to relieve the patient’s discomfort and prevent possible complications from the aneurysm in the left carotid artery.

Result

In the operation, the aneurysmatic segment was resected and sent for histopathological evaluation. Saphenous vein graft was interposed as end to end anastomosis to the proximal and distal healthy segments of the internal carotid artery.

Conclusion

This case report highlights the surgical management of a 26-year-old female patient who presented to our institution with complaints of left auricular pain, hoarseness, uncontrolled hypertension, and a pulsatile mass localized at the left cervical region and diagnosed extracranial internal carotid artery aneurysm.
Deerminants of watchdog journalism: A global empirical approach
Authors: Hamada Basyouni Ibrahim , Abdel-Salam Abdel-Salam G
Published: October 2024

This article introduces and examines a hierarchical model of influences that identifies the variables affecting the watchdog role of journalists at three levels: the societal (press freedom and democracy), the organizational (media ownership), and the individual (editorial autonomy and perceived influences) on a global scale. Using data from 27,567 journalists in 6403 media organizations across 67 countries, the model's validity is confirmed. The findings reveal that variations in journalists’ perception of their role are more pronounced at the societal level compared to the organizational and individual levels. Furthermore, journalists tend to assume a watchdog role more prominently within public media as opposed to private or state-run outlets. Surprisingly, press freedom and democracy have a weak and insignificant impact on watchdog journalism, challenging established norms in the literature, a result that we critically discussed.
Up in the air: A strategic narrative contest in the U.S.–China Balloon Incident 2023
Authors: Wong Frankie H.C. , Mulupi Dinfin
Published: October 2024

Emerging crises such as the 2023 US–China balloon incident present opportunities for states to leverage murky events to justify their behaviors, rally political support, and promote favorable worldviews through projecting strategic narratives. This study examines narratives deployed by the US and China and evaluates their diffusion in the international media environment. International news coverage of the balloon incident ( N = 776) was analyzed by a human-in-the-loop machine-learning narrative analysis. Results show the US set the tone by framing the incident as a matter of surveillance, linking the issue to identity narratives, and forcing China to engage in narrative contests on spying. The US remained dominant in the international narrative sphere although China attempted to project alternative storylines. Implications for other countries are discussed. Findings illuminate the utility of strategic narratives in unpacking strategic interactions in the flow of international political communication, in an absence of major escalations.
Three-dimensional MRI analysis of elbow anatomy and kinematics in children with ulnar dimelia
Authors: Libberecht Katleen , Huelsemann Wiebke , Hessman Per , Mann Max , Aslam Mohammad Asif , Björkman Anders
Published: October 2024

Ulnar dimelia often presents with restricted elbow movement. To develop a treatment strategy to improve elbow mobility, a detailed understanding of the skeletal deformity is needed. We created 3-D models of the cartilage and bone in the elbows of four children with ulnar dimelia by segmentation of MRI scans. We analysed the anatomy and performed a kinematic analysis. In all four children, the distal humerus was triangular in shape and consisted of a medial epicondyle, an enlarged lateral epicondyle and an anterior epicondyle. By comparing the 3-D images with conventional radiographs, we found that the projection of the enlarged lateral epicondyle created two longitudinal lines, which is a radiographic hallmark feature of the triangular-shaped distal humerus. In addition, during elbow flexion, the radial forearm bone slides along the lateral trochlea rather than rotates. This knowledge can aid surgeons to plan treatment for improving elbow mobility in ulnar dimelia.

Level of evidence: IV
Real-world efficacy of PD-1/PD-L1 inhibitors in patients with advanced pulmonary neuroendocrine carcinoma: a single-center analysis
Authors: Zhai Wanchen , Yu Ying , Wu Haicheng , Zhang Qian , Chen Yunfei , Yang Yehao , Fan Yun
Published: October 2024

Background:

Immunotherapy blocking programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) has revolutionized the treatment of extensive-stage small-cell lung cancer (SCLC), but only with limited real-world efficacy data; evidence from immunotherapy for other pulmonary neuroendocrine carcinoma (PNEC) is scarce.

Objective:

The purpose of this study is to evaluate the efficacy of receiving PD-1/PD-L1 inhibitors in patients with advanced PNEC and explore factors related to survival prognosis, providing clues for treatment for patients with advanced PNEC.

Methods:

In all, 203 patients with advanced PNEC who received PD-1/PD-L1 inhibitors between January 2019 and December 2021 were retrospectively analyzed. Kaplan–Meier curves were constructed for progression-free survival (PFS) and overall survival (OS).

Results:

For the 203 patients, the objective response rate (ORR) was 48.3%, the disease control rate (DCR) was 83.3%, the median PFS (mPFS) was 6.0 months, and the median OS (mOS) was 13.1 months. Among them, the histology was 166 SCLC, 13 large-cell neuroendocrine carcinoma, and 24 other unspecified PNEC. Histologically, no significant difference was observed in PFS ( p = 0.240) or OS ( p = 0.845). In first-line (1L) treatment ( N = 125), patients received chemoimmunotherapy and had an ORR of 64.8%, DCR of 92.0%, mPFS of 6.6 months, and mOS of 14.9 months. In second-line (2L) or later-line setting, the ORR, DCR, mPFS, and mOS were 21.8%, 69.2%, 4.4, and 9.4 months; immunotherapy plus small-molecule antiangiogenic agents showed significantly greater PFS than immunotherapy monotherapy or chemoimmunotherapy (6.4 vs 1.4 vs 3.7 months, p = 0.041). Patients without liver metastasis had superior PFS (7.0 vs 5.1 months, p < 0.001) and OS (19.2 vs 9.6 months, p < 0.001) than those with liver metastasis.

Conclusion:

In clinical practice, PD-1/PD-L1 inhibitors are effective in patients with advanced PNEC, regardless of the pathological histology. The efficacy of 1L immunochemotherapy is worthy of recognition, and the addition of small-molecule antiangiogenic agents to immunotherapy in 2L or later-line treatment provides a better survival trend.

Design:

Retrospective study.
Mediating Role of Test Anxiety in Association Between Imposter Phenomenon and Perfectionism among High-Achieving Students
Authors: Zulfiqar Najia , Abbasi Tanzeela
Published: October 2024

numerous stressors, such as test anxiety, imposter phenomenon, and perfectionism. The association between the imposter phenomenon and perfectionism is well-studied, but test anxiety as a mediator of this association is not examined. The present study aimed to explore the mediating role of test anxiety on the imposter phenomenon and perfectionism among Pakistani high-achieving students. Additionally, we investigated gender and grade differences for junior and senior high school students. In the present cross-sectional survey study, participants ( n = 250) aged 15–18 years responded to the Clance Imposter Phenomenon Scale, Frost Multidimensional Perfectionism Scale, and Westside Test Anxiety Scale. Findings showed that perfectionism increased by 39% with a one-unit increase in the imposter phenomenon. Test anxiety was a significant positive mediator of the association between imposter phenomenon and perfectionism. T-test showed girls had higher scores on the imposter phenomenon and test anxiety than boys. One-way ANOVA revealed significant educational grade differences with small effect sizes, and junior high school students scored higher than senior high school students on study variables. About 44% and 48% of 250 participants reported having moderate and frequent imposter symptoms, respectively. Almost 36.5% of high-achievers had low test anxiety, and 50% of high-achievers had normal test anxiety. The study presents a discussion of the merits and demerits.
God’s Power for Mission in Acts 1–2
Authors: Keener Craig S.
Published: October 2024

In Acts 1--2, God empowers Jesus's followers with the Spirit to proclaim Jesus's saving kingdom across all cultural barriers, to worship God, and to form one new, multicultural community of worshipers committed to Christ and to one another.
Urban state venturism or urbanization of state capital? Views from the global East
Authors: Shin Hyun Bang
Published: October 2024

While appreciating the novelty of conceptualizing urban state venturism, this commentary proposes that the state's role as capital can be clearly evidenced by the urbanization of state capital, which involves the active deployment of state-owned corporations in the global East amid the region's pursuit of condensed and developmental urbanization and industrialization.
Low-frequency repetitive transcranial magnetic stimulation for the treatment of post-traumatic stress disorder and its comparison with high-frequency stimulation: a systematic review and meta-analysis
Authors: Jiang Che , Yang Yong , Wu Lili , Liu Weizhi , Zhao Gang
Published: October 2024

Background:

Repetitive transcranial magnetic stimulation (rTMS) showed potentially beneficial effects for the treatment of post-traumatic stress disorder (PTSD). Low-frequency (LF) rTMS decreases neuronal excitability and may have better safety compared to high-frequency (HF) rTMS. However, there lacks meta-analysis specifically focusing on LF rTMS.

Objectives:

To specifically explore the efficacy and safety of LF rTMS for treating PTSD.

Methods:

Databases including PubMed, EMBASE, MEDLINE, and Web of Science were systematically searched from inception to October 17, 2023. Both randomized controlled trials (RCTs) and open trials of LF rTMS on PTSD were included, and we additionally included RCTs comparing HF rTMS and sham treatment on PTSD. First, we qualitatively summarized parameters of LF rTMS treatment; then, we extracted data from the LF rTMS treatment subgroups of these studies to examine its effect size and potential influencing factors; third, we compared the effect sizes among LF rTMS, HF rTMS and sham treatment through network meta-analysis of RCTs.

Results:

In all, 15 studies with a sample size of 542 participants were included. The overall effect size for LF rTMS as a treatment for PTSD was found as Hedges’ g = 1.02 (95% CI (0.56, 1.47)). Meta-regression analysis did not reveal any influencing factors. Network meta-analysis showed that compared to sham treatment, only HF rTMS on the right dorsolateral prefrontal cortex (DLPFC) demonstrated a significant advantage in ameliorating PTSD symptoms, while LF rTMS on the right DLPFC showed a trend toward advantage, but the difference was not significant.

Conclusion:

The current literature shows LF rTMS has effect in treating PTSD caused by various traumatic events. However, present limited number of RCT studies only showed LF rTMS to have a trend of advantage compared to sham treatment in treating PTSD caused by external traumatic events. In the future, more RCTs are needed to be made to confirm the efficacy of LF rTMS. Additionally, studies are required to elucidate the underlying mechanism in order to further improve its efficacy in different traumatic populations.

PROSPERO registration number:

CRD42023470169.
Impact of a new post-emergency teleconsultation procedure on overcrowding
Authors: Chavda Emmanuelle , Norberciak Laurene , Guedon Moreau Laurence , Casalino Enrique , Williatte Lina , Wiel Eric , Thellier Nicolas , Cordova Enrique
Published: October 2024

Background

Saint Vincent de Paul Hospital is using a post-emergency teleconsultation solution (TELESCOPE). Target patients are discharged early, freeing up examination rooms and hospital beds, and the patient's clinical evolution is monitored by teleconsultation 24 hours after discharge. This study aims to evaluate this pioneering procedure, firstly to assess the impact of TELESCOPE on ED overcrowding, and secondarily to evaluate 72-hour post-emergency hospitalization rates, throughput times, and patient satisfaction.

Methods

This is a prospective, comparative, before/after type study. The National Emergency Department Overcrowding Scale (NEDOCS) score was used to measure the impact of TLC on ED congestion. It was calculated every hour, every day during the two study periods. The 72-hour post-emergency hospitalization rates were cross-compared for the patients who had a TLC, those who did not have a TLC during the same period, and those from the control period. The patient flow was evaluated by comparing the average length of stay of patients invited to a TLC against those from the control period. The patient’s satisfaction was measured through a telephone survey.

Findings

The mean difference in NEDOCS score is −3.1 [−4.14; −1.85]. Compared to the control phase, ED spent an additional 160 hours at a ‘normal’ level during the test period. The time spent in the ‘busy’ or ‘overcrowded’ categories was reduced by 129 and 19 hours. There is a significant reduction in the hospitalization rate between teleconsultation patients and all other patients. The patients discharged and invited to a TLC waited 87 minutes longer on average [56 minutes; 119 minutes]. Patient satisfaction is high (91.8%).

Interpretation

Additional statistical strength would be needed to prove a reduction in overcrowding. The low hospitalization rate reflects adequate recruitment. ED visit times were unexpectedly longer. TELESCOPE seems useful for defining a new type of care. A further multicentre study is scheduled for 2024.
The Association Between Hounsfield Units and Mechanical Failure in ASD Patients
Authors: Heegaard Martin , Ingadottir Kristin , Ragborg Lærke , Dahl Benny , Hansen Lars Valentin , Ohrt-Nissen Søren , Gehrchen Martin
Published: October 2024

Study design

Retrospective Cohort Study.

Objectives

Low bone mineral density (BMD) is a known risk factor for revision surgery in patients with adult spinal deformity (ASD). Hounsfield units (HUs) on CT scans have been suggested as a proxy for assessing BMD. This study aimed to determine HUs in the lumbar region and their association with mechanical failure in patients undergoing ASD surgery.

Methods

We included ASD patients undergoing surgery from 2010-2020 with minimum 2-year follow-up. We excluded patients without preoperative CT scans, or a CT scan more than 1 year before surgery. Mechanical failure was defined as proximal junctional failure, pseudarthrosis, or implant failure requiring revision surgery. On preoperative CT scans, HUs were measured on 3 axial slices on each vertebra from L1-L5 and, if available, at UIV and UIV + 1.

Results

We included 170 patients, mean age 63 (±12) years, with 108 (64%) females, and 13 [IQR 10-16] instrumented levels. Mechanical failure occurred in 27% (n = 46) of patients at 2-year follow-up. Mean lumbar HUs were 146 (±51) in the mechanical failure group and 135 (±52) in those without revision ( P = .232). Area under the curve was 0.58 (95% CI: 0.48-0.68), corresponding to no to low discriminatory power in predicting mechanical failure using lumbar HUs. Univariate logistic regression revealed no significant difference between mechanical failure and lumbar HUs (OR = 1.00, 95% CI: 1.00-1.01, P = .239).

Conclusions

We found no association between mechanical failure and HUs on preoperative CT scans in ASD patients. Thus, we cannot recommend using HUs to predict mechanical failure in these patients.
Muscle Architecture Properties of the Deep Region of the Supraspinatus: A Cadaveric Study
Authors: Wu Isabella T. , Hyman Sydnee A. , Norman Mackenzie B. , Sendek Gabriela , Powell Jenna J. , Kirchberg Tyler N. , Berry David B. , Lane John G. , Singh Anshuman , Ward Samuel R.
Published: October 2024

Background:

The supraspinatus is most frequently involved in rotator cuff tears, a common orthopaedic condition. However, the architecture of this muscle has been described only for the superficial, anterior, and posterior regions.

Purpose:

To determine the muscle architecture of the deep supraspinatus.

Study Design:

Descriptive laboratory study.

Methods:

Muscle architecture measurements were collected from 25 cadaveric supraspinatus specimens (13 intact [without tendon tears], 3 with partial-thickness tears, 9 with full-thickness tears). The muscle was divided into deep, superficial anterior, and superficial posterior regions. Pennation angle, raw and normalized fiber length, and sarcomere length and number were compared using repeated-measures analyses of variance.

Results:

First, mean architecture measurements were compared between regions using only the intact specimens (n = 13). The deep region had a lower mean pennation angle (3.3° ± 1.0°) compared with the posterior region (11.0° ± 3.9°; P < .0001), which in turn had a significantly higher pennation angle compared with the anterior region (7.6 ± 2.6°; P = .0005). Normalized fiber lengths in the deep region were 21.1% ( P = .0052) and 34.5% ( P < .0001) shorter than the posterior and anterior normalized fiber lengths, respectively. Sarcomere lengths in the deep region were longer (3.4 ± 0.2 μm) compared with the posterior (3.1 ± 0.2 μm; P = .0012) and anterior (3.2 ± 0.2 μm; P = .0390) regions. Sarcomere numbers also decreased in the deep region by 21.2% ( P = .0056) and 34.2% ( P < .0001) compared with the posterior and anterior regions, respectively.

Conclusion:

The deep supraspinatus had significantly lower pennation angles, shorter fiber lengths, and fewer but longer sarcomeres in series compared with other subregions within the muscle. These structural differences suggest a functionally unique “submuscle” within the supraspinatus.

Clinical Relevance:

Understanding the architecture of the supraspinatus muscle can provide insight into muscle function in health and disease. Specifically, this deep submuscle may play a different role in rotator cuff function than the rest of the muscle.
Embodied and Contextual Intelligence: Towards a Policy Framework for Higher Education
Authors: Prabakaran Madhu
Published: October 2024

This article explores the diverse epistemic perspectives on intelligence, tracing its conceptual evolution across early Indian philosophy, Western philosophical thought and contemporary computational theories. Intelligence is examined as a dynamic, multifaceted phenomenon that transcends mere cognition, extending into embodied, ecological and meta-intelligent domains. The discussion juxtaposes traditional views—where intelligence is seen as a divine or innate quality, a product of sagacious prudence, or a computational system—with more contemporary understandings that emphasize the role of context, embodiment and ecological interaction. Through a critique of pancomputationalism and an exploration of the non-computable aspects of intelligence, the article argues for a more holistic view that recognizes intelligence as an adaptive, contextually grounded and evolutionarily emergent property.
Evidence Synthesis for the Development of National Nursing-Sensitive Indicators in Malaysia: A Literature Review and Stakeholder Engagement Approach
Authors: Rata Mohan Devi Shantini , Jamalul-lail Nurul Iman , Chong Diane Woei-Quan , Chelladorai Kalvina , Mohammad Zubairi Kartiekasari Syahidda , Rusli Inin Roslyza , Zainuddin Nur Azmiah , Supadi Roslina , Ab Rahman Noor Hasidah , Mohamad Mariyah , Saravana Muthu Devi K. , Narayanan Gowry , Jenny Cheah
Published: October 2024

Introduction

Nursing-sensitive indicators measure and evaluate nursing care quality and its contribution to patient care. The identification of indicators that demonstrate nursing care contribution and the quality of care delivered locally is of paramount importance, and national indicators that demonstrate this are essential. This paper aims to provide an evidence base of nursing-sensitive indicators that can facilitate the conceptualization of local nursing national indicators.

Method

A multifaceted and iterative approach incorporating literature review, and stakeholder engagements was utilized in evidence synthesis. A review of indicators present internationally complemented by the inclusion of context-specific local NSIs through stakeholder engagements was performed. Secondary data analysis of documents from an environmental scan was also included to highlight areas of concern for nursing-sensitive indicator prioritization from the viewpoint of nurses.

Results

A total of 64 articles were reviewed and indicators were coded according to the Nursing Care Performance Framework subsystems, dimensions, and variables. All papers reviewed had documented outcome indicators. From our secondary data analysis, nurses identified areas of concern such as nursing staff supply, staff maintenance, nursing processes and risk outcomes, and safety to be prioritized for developing quality indicators.

Conclusion

This paper provides a list of NSIs coded systematically with definitions to aid stakeholders in prioritizing indicators for national indicator development. The inclusion of areas of concern provides insight into NSIs that nurse practitioners find relevant to the local context. To our knowledge, this is the first paper that includes evidence available in the literature and incorporates stakeholders’ perspectives in synthesizing evidence needed to guide the development of national nursing indicators. This iterative approach is crucial because it enhances the likelihood of knowledge translation.
Endovascular treatment versus medical management for basilar artery occlusion with low-to-moderate symptoms (National Institutes of Health Stroke Scale < 10)
Authors: Dargazanli Cyril , Mourand Isabelle , Mahmoudi Mehdi , Poirier Laurence , Labreuche Julien , Weisenburger-Lile David , Gory Benjamin , Richard Sébastien , Ducroux Célina , Piotin Michel , Blanc Raphael , Lucas Ludovic , Marnat Gaultier , Aubertin Mathilde , Arquizan Caroline , Bourcier Romain , Detraz Lili , Vannier Stéphane , Guillen Maud , Eugene François , Walker Gregory , Lun Ronda , Dowlatshahi Dariush , Shamy Michel , Consoli Arturo , Costalat Vincent , Lapergue Bertrand , Maïer Benjamin , Guenego Adrien , Fahed Robert
Published: October 2024

Background:

Patients with acute basilar artery occlusion (BAO) and low-to-moderate symptoms (National Institutes of Health Stroke Scale [NIHSS] < 10) are poorly represented in thrombectomy trials. Our objective is to compare thrombectomy and best medical management (BMT) in this population.

Methods:

We compared data of all consecutive patients presenting with an initial NIHSS < 10 and acute symptomatic BAO included in two registries. The main outcome was the proportion of patients achieving a 3-months favorable outcome (mRS 0-2 or equal to the pre-stroke value). Secondary outcomes included the proportion of patients with an excellent outcome (mRS 0-1 or equal to pre-stroke value), overall mRs distribution (shift analysis) and mortality. Effect sizes for thrombectomy versus BMT alone were calculated using binary or ordinal logistic regression model before after considering confounders using the inverse probability of treatment weighting (IPTW) propensity score method.

Results:

One hundred twenty-seven patients were included: sixty-four patients treated with thrombectomy (mean ± SD age: 63.4 ± 16.1) and sixty-three with BMT (mean ± SD age: 69.0 ± 14.3). There was no significant difference between groups for the rate of 3 month-favorable outcome or mortality. After propensity-score adjustment, thrombectomy was associated with a significantly higher chance of excellent outcome at 3 months (mRS 0-1 or equal to pre-stroke value; adjusted OR, 2.68; 95%CI, 1.04–6.90; p = 0.041).

Conclusion:

Our study suggests that thrombectomy in patients with low-to-moderate symptoms (NIHSS < 10) due to BAO does not improve the rate of favorable outcome but could lead to a higher chance of excellent outcome at 3 months. Trial Registration: ETIS Registry. http://www.clinicaltrials.govNCT03776877
Using Lean Six Sigma Methods to Develop an Efficient and Sustainable Interdisciplinary Team Program for Chronic Pain in a VA: PREVAIL Interdisciplinary Team Track
Authors: Courtney Rena E. , Schadegg Mary J. , Hicks Natalie , Truitt Melissa , Bolton Rendelle E , Dezzutti Brian , Cannizzo Francis , Darnall Beth D. , Radatz Marilyn , Harden Samantha M.
Published: October 2024

Background

Chronic pain is highly prevalent in US military Veterans, and pain interdisciplinary teams (IDTs) are the gold standard in pain care. There is no standard or guidance for how best to develop and implement pain interdisciplinary teams within complex health care systems.

Objectives

The purpose of this quality improvement project was to evaluate the effectiveness of the standard 9-step Lean 6 Sigma (LSS) methodology in redesigning a pre-existing VA outpatient pain clinic solely offering interventional pain services into an efficient, sustainable pain IDT program.

Methods

The initial evaluation process at a VA Medical Center that primarily serves rural Veterans was redesigned with the a priori goal of developing an efficient, sustainable IDT program that decreased driving days (ie, in-person appointments) required for a comprehensive initial pain evaluation, decreased number of consults required for initial pain evaluations, increased the number of consults to Whole Health services, and increased compliance with policies and standards. Feedback from administrators, clinicians, and Veterans was used to identify inefficiencies then iteratively design, test, and finalize a redesigned service called the PREVAIL Interdisciplinary Team Track (PREVAIL IDT Track). Baseline data was collected for 1 year followed by sustainment data for 14 months. Results were analyzed using descriptive statistics.

Results

PREVAIL IDT Track decreased the number of in-person appointments from 5 to 2, decreased consults required for evaluations from 5 to 1, increased the number of unique consults to Whole Health education classes, and made the VA fully compliant with policies and standards. To date, 486 Veterans have participated in the redesigned program, including 167 graduates and 212 current enrollees in this sustained clinical program.

Conclusion

The success of PREVAIL IDT Track suggests that LSS may be a promising method for redesigning sustainable pain IDTs in VA that improve efficiency.
Watt sense of community? A human geography agenda on energy communities
Authors: Sareen Siddharth , Haarstad Håvard , Gong Huiwen , Aiken Gerald , Skjølsvold Tomas Moe , Silvester Benjamin Ronald , Popovic-Neuber Jelena , Stopa Mateusz , Lindkvist Mathias , Pezzotta Micol , Sasse Lea , Shokrgozar Shayan , Haugland Bård Torvetjønn , Langhelle Oluf , Inderberg Tor Håkon Jackson
Published: October 2024

Energy communities can potentially advance just transitions towards low-carbon systems by devolving energy production and consumption to local scales. During vibrant debates on evolving energy geographies for more than a decade, human geographers have engaged with conceptualization and emergent models of energy communities in generative ways. We argue for a research agenda where these understandings of space, place and scale enhance research on energy communities. Three points hold particular importance and relevance for this agenda: (a) Pluralising understandings of energy communities, (b) Spatializing perspectives on the potential of energy communities to advance just transitions, and (c) Contextually situating technological-energy innovation strategies.
An investigation of autistic opinions about autism-related genomic research
Authors: Ellis Rebecca M , Asbury Kathryn
Published: October 2024

Genomic studies of autism are a heavily debated, often controversial, topic within the autism community. Autistic voices have historically been poorly represented within research which concerns them directly. Although recent efforts have been made to involve the voices of those with lived experience, there is a dearth of knowledge of Autistic opinions of genomic autism studies. This study sought to address this. This research has collected the views and opinions of late-diagnosed Autistic adults on genomic research as part of the PEAPOD (Personal Experiences of Autism and Perceptions Of DNA-based research) study. It consisted of 20 semi-structured interviews with Autistic adults residing in the UK, conducted by an Autistic researcher. The study used multiple data collection methods including using video conferencing software and social media messaging. Interviews were transcribed and thematically analysed. Four themes were identified including a diverse understanding of genomic research, what is genomic research seeking to achieve? who is doing what? (and for whom?), and reflecting on the Autistic voice. We conclude more is needed to address the concerns of the Autistic community surrounding genomic studies and suggest recommendations for how this can be achieved.