bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility of Single - Encounter Telemedicine Lung Cancer Screening: A Retrospective Cohort Study in an Underserved Population
Authors: Magarinos Jessica , Lutzow Lynde , Dass Chandra , Ma Grace X. , Erkmen Cherie P.
Published: March 2023

Background

COVID-19 forced a delay of non-essential health services, including lung cancer screening. Our institution developed a single-encounter, telemedicine (SET) lung cancer screening whereby patients receive low-dose CT in-person, but counseling regarding results, coordination of follow-up care and smoking cessation is delivered using telemedicine. This study compares outcomes of SET lung cancer screening to our pre-COVID, single-visit, in-person (SIP) lung cancer screening.

Methods

A retrospective cohort study was performed we recorded independent variables of gender, race/ethnicity, age, educational attainment, smoking status and dependent variables including cancer diagnosis, stage and treatment between March 2019 to July 2021. Using retrospective analysis, we compared outcomes of SIP lung cancer screening before COVID-19 and SET lung cancer screening amid COVID-19.

Results

There was a significant difference in number of patients screened pre- and amid COVID-19.673 people were screened via SIP, while only 440 were screened via SET. SIP screening consisted of 52.5% Black/African American patients, which decreased to 37% with SET lung cancer screening. There was no significant difference in gender, age, or educational attainment. There was also no significant difference in Lung–RADS score between the 2 methods of screening or diagnostic procedures performed. Ultimately telemedicine based screening diagnosed fewer cancers, 1.6% diagnosed via telemedicine vs 3.3% screened by in person.

Conclusion

We implemented SET lung cancer screening to continue lung cancer screening during a global pandemic. Our study established feasibility of telemedicine-based lung cancer screening among our predominantly African American/Black population, though fewer patients were screened. We found no difference in distribution between age, or educational attainment suggesting other factors discouraging lung cancer screening amid COVID-19.
Follow-up of retinoblastoma using RetCam fluorescein angiography and correlation with clinical findings
Authors: Gündüz Ahmet Kaan , Tetik Diğdem
Published: March 2023

Purpose

To report RetCam fluorescein angiographic (FA) changes and correlation with clinical findings in the follow-up of retinoblastoma (RB) after frontline intravenous chemotherapy and other treatments.

Methods

Patients having RB who underwent post-treatment RetCam fundus photography and FA under general anesthesia between February 2020 and February 2022 were retrospectively analyzed.

Results

78 eyes of 70 patients with RB were included. In 55 (70.5%) eyes with type 1, 2 or 3 regression patterns, the main tumor started to show hyperfluorescence in arterial phase in 24 eyes (43.6%), in early venous phase in 24 (43.6%) eyes, and in late venous phase in 7 (12.7%) eyes. Of thirty-six (46.2%) eyes with chorioretinal scars developing after focal treatments (cryotherapy and transpupillary thermotherapy), window defects and visible choroidal vessels were found in all eyes, scleral staining in 10 (27.8%), and gliosis on scar tissue in 8 (22.2%). Vitreous seeds showed hyperfluorescence if they were calcified (6 eyes, 7.7%) and hypofluorescence if non-calcified (11 eyes, 14.1%). Retrohyaloid seeds (11 eyes, 14.1%) were hypo/isofluorescent while subretinal seeds (6 eyes, 7.7%) were hyperfluorescent. Leakage from peripheral retinal vessels was detected in 14 (17.9%) eyes and non-perfusion in 6 (7.7%) eyes.

Conclusion

RetCam wide-angle FA is useful to evaluate the tumor and associated vascular and retinal changes after treatment in RB. Regressed tumors demonstrate later fluorescein uptake in venous phases. Fluorescein angiographic changes in chorioretinal scars include window defects, visibility of choroidal vessels, scleral staining, and leakage from vessels. Retinal vascular leakage and peripheral non-perfusion can be seen in eyes with regressed stable tumors.
Green hotel practices and consumer revisit intention: A mediating model of consumer promotion focus, brand identification, and green consumption value
Authors: Dang-Van Thac , Vo-Thanh Tan , Wang Jianming , Nguyen Hoang Viet , Nguyen Ninh
Published: March 2023

This study examines the relationship between green hotel practices and consumer revisit intention, with the mediating mechanisms of brand identification, promotion focus, and green consumption value. A paper-based survey was conducted to collect data from consumers in four-star or above hotels in China. Findings from multivariate data analysis show that green hotel practices positively influence consumer to revisit intention, which is mediated by brand identification and green consumption value. Moreover, consumer promotion focus positively mediates the relationship between green hotel practices and brand identification. The findings validate a unique multi-path mediating model of green hotel practices. They also have important implications for hotel managers interested in developing genuine environmental initiatives to generate positive customer responses.
Together we will rise? Perceptions of instrumentality and normalization as motivations for joint collective action among the disadvantaged
Authors: Hasan-Aslih Siwar , Pliskin Ruthie , Shuman Eric , van Zomeren Martijn , Saguy Tamar , Halperin Eran
Published: March 2023

The current research examines joint collective action between advantaged and disadvantaged groups, from the perspective of the latter. We hypothesize that joint action poses a dilemma which lies in the tension between perceived instrumentality of joint action (i.e., ability to promote the disadvantaged’s goals) and perceived normalization (i.e., its tendency to blur power relations). We test this idea across three studies in the United States and Israel/Palestine. In Study 1 ( n = 361) we manipulated perceptions of joint action from the perspective of a hypothetical character, and in Study 2 ( n = 378) we presented participants with an article highlighting the risk and benefit of joint activism. Results showed that perceived instrumentality increases, whereas perceived normalization decreases joint action tendencies. In Study 3 ( n = 240), we described a joint action event that taps into some of the themes that induce concerns about normalization. We found that normalization perceptions feed into perceptions of instrumentality, and this occurred mainly among high identifiers, for whom the dilemma is most salient. The implications of these findings for understanding the complexity of joint collective action from the perspective of the disadvantaged are discussed.
Simulation-based study on active tilt controlled narrow tilting three-wheeler considering road bank angle
Authors: Dandiwala Ankitkumar , Sindha Jigneshsinh , Chakraborty Basab , Chakravarty Debashish
Published: March 2023

The issues like traffic congestion, parking space and vehicular emission can be reduced by adopting electric narrow tilting three-wheelers, which can also provide a cost-effective and safe mode of transport for low-income people. According to energy technology perspectives 2017, well-to-wheel global greenhouse gas emissions can be reduced up to 1.3 GtCO2-eq by 2060 by adopting electric mobility. This study presents a new and modified SDTC strategy and performance parameters that takes Road Bank Angle (RBA) into account so as to exhibit the adverse effects on rollover safety, ride comfort in terms of the perceived lateral acceleration and desired trajectory. Besides, this study identifies the importance of the RBA consideration in active tilt controlled vehicle for the scenario of parking on sloped surface. Simple electronic control architecture of the SDTC approach with real-time RBA consideration is proposed to address the limitations of SDTC and its supplementary advantages. This study evaluates the scenario of constant turn manoeuvre and vehicle parking on the banked roads. A multi-body model is used to capture the dynamic characteristics of the vehicle, whereas a characteristic of the Tilt Actuation System (TAS) and Active Steering (AS) system is incorporated in the form of a Transfer Function (TF) estimated using a system identification approach. The results indicate that the inclusion of a real-time RBA in the SDTC enables it to maintain steady-state torque and perceived lateral acceleration close to zero with the proposed controlled strategy, and it also keeps the vehicle upright on the sloped surface. It may be concluded that RBA compensation improves the ease of handling the vehicle while parking or riding on a sloped surface without significant control system alterations, which also makes it a viable alternative for physically disabled people.
The electoral consequences of compensation for globalization
Authors: Rickard Stephanie J
Published: March 2023

As opposition to globalization grows, many governments seek policy responses. One response – the European Globalisation Adjustment Fund – provides support to workers in European Union member states who are made redundant as a result of globalization. Proponents argue that by offsetting some of the costs of globalization, the programme may bolster public support for international economic integration and the political parties that support it. I investigate the impact of the European Globalisation Adjustment Fund on voters’ support for protectionist political parties using a difference-in-differences research design and official election results at the district and commune level. I also examine individual-level voting data. I find that in regions exposed to rising imports, assistance from the European Globalisation Adjustment Fund generates a small decrease in the vote share of one of Europe’s most prominent anti-globalization parties, which ranges in magnitude from 0 to 1.5 percentage points. While consistent with the logic of embedded liberalism, the finding suggests that the theorized connection between compensation and support for globalization may be conditional rather than categorical.
Full-range bolt preload monitoring with multi-resolution using the time shifts of the direct wave and coda waves
Authors: Chen Dongdong , Zhang Nini , Huo Linsheng , Song Gangbing
Published: March 2023

A bolt may undergo a process from slight preload perturbation to significant preload reduction during its service life, it is a challenge to simultaneously detect both slight and significant bolt looseness based on the same waveform. Previous studies were prone to use direct wave or coda waves individually, which is suitable for a narrow range of bolt preload and cannot realize the full-range bolt preload reduction. To address this challenge, this article proposes a novel full-range bolt preload monitoring approach with multi-resolution using the time shifts of the direct wave and coda waves. Due to the difference in propagation paths, preload reduction induced time shift varies considerably between the direct wave and coda waves. By calculating the time shifts of the direct wave and coda waves, bolt looseness, including the slight preload perturbation and the significant preload reduction, can be simultaneously estimated. Based on the acoustoelastic effect and the wave path summation, a theoretical model is established, and the monitoring principles are presented. The analytical results show that the time shifts of the direct wave and coda waves are proportional to the preload variations. Validation experiments are carried out, and the results show that at specific preloading levels, the ultimate detectable resolutions of bolt preload (DRBP) using direct wave and coda waves are 1.68% and 0.32%, respectively. Therefore, the ultimate DRBP of the direct wave is 5.25 times that of the coda waves, indicating that the coda waves can be used as the “probe” with high resolution to detect tiny perturbations of preload, and the direct wave can function as a low-resolution “probe” to monitor significant preload deterioration. By calculating the time shifts of the direct wave and the coda waves, bolt looseness with different degrees can be monitored simultaneously.
Democracy and the Corruption of Speech
Authors: Warren Mark E
Published: March 2023

In the developed democracies, the public discourse of political corruption and conspiracy remains stubbornly pervasive, in spite of the fact that these countries are, comparatively, the cleanest in the world. Everyday talk about corruption expresses a politics of distrust and disaffection, corrodes deliberative responses to political conflict and – most alarmingly – can be mobilized by populist authoritarians who would replace democratic institutions with decisionism. The phenomenon that Rosenblum and Muirhead call ‘the new conspiracism’ – assertions of conspiracies without evidence or even claims that could be refuted – is deepening the discourse of corruption, particularly in the United States. These discourses are expressive rather than discursive: they cannot be refuted because they signal fears and discontents rather than positions within public arguments. Because democracies only work when they channel political conflict into credible speech, these developments corrode the life-blood of democracies. A key problem for democrats today is to diagnose this pathology, identify powers of speech and devise responses that might protect the common pool resource of promise and commitment in speech-based politics.
Adult Sexual Assault Patients’ Experience of the Physical Examination Component of the Medical Forensic Examination: A Scoping Review to Identify Gaps in the Research Literature
Authors: Stewart Mary Louise , Shackel Rita , Freedman Eleanor , Templeton David James
Published: March 2023

We undertook a scoping review of published research literature that reported on adult sexual assault patients’ experience of the physical examination component of the medical forensic examination (MFE). Eligible papers were those reporting data about the physical examination component of the MFE from the adult patient’s perspective, published in the period January 2000 to March 2022 in peer reviewed journals and reports containing original research data published from a tertiary institution. Twelve papers were identified. The review identified a gap in the literature regarding the patient’s experience of the physical examination component of the MFE. The existing literature is limited but suggests that some patients find the examination empowering and reassuring, restoring a sense of bodily control; however, for others it is an intrusive, violating experience that they endure. A more patient-centered sexual assault service appears to have a therapeutic value in itself, but more research is warranted as existing research is very limited and often from a proxy. In particular, more research on patients’ self-reported experience of the MFE, including specific aspects of the examination and the experience of male and gender nonconforming victim-survivors, is needed. A better understanding, from the point of view of the patient, of the benefits of attending, may encourage victim-survivors to seek a health response and, possibly, report to police. It may also be time to assess the impacts of certain aspects of the forensic examination, rethink standard evidence collection processes, and consider enabling more acceptable options for victim-survivors including self-collection of intimate samples.
Case-to-factor Ratios and Model Specification in Qualitative Comparative Analysis
Authors: Thiem Alrik , Mkrtchyan Lusine
Published: March 2023

Qualitative comparative analysis (QCA) is an empirical research method that has gained some popularity in the social sciences. At the same time, the literature has long been convinced that QCA is prone to committing causal fallacies when confronted with non-causal data. More specifically, beyond a certain case-to-factor ratio, the method is believed to fail in recognizing real data. To reduce that risk, some authors have proposed benchmark tables that put a limit on the number of exogenous factors given a certain number of cases. Many applied researchers looking for methodological guidance have since adhered to these tables. We argue that fears of inferential breakdown in QCA due to an “unfavorable” case-to-factor ratio are without foundation. What is more, we demonstrate that these benchmarks induce more fallacious inferences than they prevent. For valid causal inference, researchers are better off relying on the current state of knowledge in their respective fields.
Utilization of Diaphragm Motion to Predict the Displacement of Liver Tumors for Patients Treated with Carbon ion Radiotherapy
Authors: Li Yao , Tang Wumiao , Zhang Jiangbing , Bu Ruirui , Hsi Wenchien , Li Yongqiang
Published: March 2023

Objectives: To establish and validate a linear model utilizing diaphragm motion (DM) to predict the displacement of liver tumors (DLTs) for patients who underwent carbon ion radiotherapy (CIRT). A total of 60 pairs of planning and reviewing four-dimensional computed tomography (4DCT) sets over 23 patients were used. Method: We constructed an averaged computed tomography (CT) set for each either planning or reviewing 4DCT within respiratory phases between 20% of exhale and inhale. A rigid image registration to align bony structures was performed between planning and reviewing 4DCT. The position changes on top of diaphragm in superior–inferior (SI) direction between 2 CTs to present DM were obtained. The translational vectors in SI from matching to present DLT were obtained. The linear model was built by training data for 23 imaging pairs. A distance model utilized the cumulative probability distribution (CPD) of DM or DLT and was compared with the linear model. We conducted the statistical regression analysis with receiver operating characteristic (ROC) testing data of 37 imaging pairs to validate the performance of our linear model. Results: The DM within 0.5 mm was true positive (TP) with an area under the ROC curve (AUC) of 0.983 to predict DLT. The error of predicted DLT within half of its mean value indicated the reliability of prediction method. The 23 pairs of data showed (4.5 ± 3.3) mm for trend of DM and (2.2 ± 1.6) mm for DLT. A linear model of DLT = 0.46*DM + 0.12 was established. The predicted DLT was (2.2 ± 1.5) mm with a prediction error of (0.3 ± 0.3) mm. The accumulated probability of observed and predicted DLT with < 5.0 mm magnitude was 93.2% and 94.5%, respectively. Conclusion: We utilized the linear model to set the proper beam gating for predicting DLT within 5.0 mm to treat patients. We will investigate a proper process on x-ray fluoroscopy images to establish a reliable model predicting DLT for DM observed in x-ray fluoroscopy in the following two years.
Public participation at the local level in China—How does it work? A perspective from within
Authors: AbouAssi Khaldoun , Wang Rui
Published: March 2023

Public participation is widely adopted in managing public affairs, especially at the central level in many countries. This article examines the current status of public participation in a Chinese local government environmental agency, through the eyes of its employees. We find that informational and consultative forms of public participation are common; other forms of participation that require decision authority sharing are not absent. Regardless, public participation is perceived to be used for its instrumental benefits. The lack of time for citizens to participate and for the agency to manage participation are the major obstacles; the need for a top political decision and more public awareness are needed for the agency to engage the public meaningfully. The good news is that most public sector employees, especially managers, hold a positive view of public participation.
The Ottoman Imperial Gaze: The Greek Revolution of 1821–1832 and a New History of the Eastern Question
Authors: Ozavci Ozan
Published: March 2023

This article traces what hindsight shows to be the failure paths of the Ottoman ruling elites in dealing with the Greek revolution of 1821–1832. It considers why Sultan Mahmud II and the Ottoman ministers were unable to quell the ‘insurgence’ definitively and fend off Great Power intervention diplomatically. To this end, it looks into the reaction of the Ottoman rulers to the adversity as well as rivalries among the pashas of the sultan, which strained the imperial front, heightened violence against the insurgents, and then tore apart the military campaign. At the same time, it seeks to re-instate in the historiography of the Eastern Question the much-neglected Ottoman positionality with a contrapuntal approach. It places the agency of European and Ottoman actors within the same analytical frame in its discussion of the Great Power intervention in 1827, disclosing why the Ottoman ministers rejected the European Powers’ proposals to mediate between the imperial authorities and the Greek revolutionaries. Consulting fresh archival and secondary sources in the Arabic, English, French, Russian, Ottoman, and modern Turkish languages, the article draws attention to several overlooked yet vital moments of the revolution's storyline.
Does obesity predict morbidity and mortality amongst patients undergoing transfemoral amputations?
Authors: Bokhari Syed MMA , Sambandam Senthil , Tsai Shirling , Nathan Vishaal S , Senthil Tejas , Lanier Heather , Huerta Sergio
Published: March 2023

Background

We investigated the role of obesity on morbidity and mortality in patients undergoing above knee amputation.

Methods

Data of 4225 patients undergoing AKAs was extracted from NIS Database (2016–2019) for a retrospectively matched case-control study and were grouped into; Non-obese (N-Ob-BMI <29.9 kg/m2; n = 1413), class I/II obese (Ob-I/II-BMI: 30–39.9 kg/m2; n = 1413), and class III obese groups (Ob-IIIBMI > 40; n = 1399). Morbidity, mortality, length of stay, and hospital charges were analyzed.

Results

Blood loss anemia (OR = 1.42; 95% CI = 1.19–1.64), superficial SSI (OR = 5.10; 95% CI = 1.4717.63) and acute kidney injury (AKI- OR = 1.42; 95% CI = 1.21–1.67) were higher in Ob-III patients. Mortality was 5.8%, 4.5%, and 6.4% in N-Ob, Ob-I/II and Ob-III patients ( p < 0.001; Ob-I/II vs. Ob-III), respectively. Hospital LOS was 3 days higher in Ob-III (16.1 ± 18.0), comparatively resulting in $25,481 higher inpatient-hospital charge.

Conclusion

Patients in Ob-III group were noted to have increased morbidity, higher LOS, and inpatient-hospital cost.
Understanding the Link between COVID-19 and HIV/AIDS Stigmas
Authors: Wong Newman Chun Wai , Paat Yok-Fong
Published: March 2023

While the HIV/AIDS epidemic has informed the responses to the COVID-19 pandemic, there is a lack of understanding of the empirical links between stigmas associated with COVID-19 and HIV/AIDS. Surveying 247 adults in the United States online, this study aims to examine the relationships between COVID-19 and HIV/AIDS stigmas in order to understand how they are similar and different from each other, taking into consideration the context relevant to the COVID-19 pandemic. Four scales of stigmas conveying different attitudes (i.e., rejection, despise, accusation, and caution) were used to examine the relationships between the stigmas of these two infectious diseases. Findings based on the mean comparisons from paired t tests showed the mean difference in scores between respondents who supported the exclusion of COVID-19-infected individuals versus HIV-infected individuals was statistically significant. In addition, the mean difference in scores between respondents who were wary of their need to protect their rights around COVID-19-infected persons versus HIV-infected persons was statistically significant. Controlling for the respondents’ sociodemographics and factors that were relevant to the COVID-19 pandemic, multiple regression analyses showed that all four types of COVID-19 stigmas were positively associated with their corresponding types of HIV/AIDS stigmas. The preliminary findings between COVID-19 and HIV/AIDS stigmas suggested that HIV/AIDS stigma mitigation strategies may present a fruitful approach to inform stigma mitigation of COVID-19.
Female Athletes With Better Psychological Readiness Are at Higher Risk for Second ACL Injury After Primary ACL Reconstruction
Authors: Zarzycki Ryan , Cummer Kathleen , Arhos Elanna , Failla Mathew , Capin Jacob J. , Smith Angela H , Snyder-Mackler Lynn
Published: March 2023

Background:

Approximately 1 in 4 athletes returning to sports will sustain a second anterior cruciate ligament (ACL) injury. Psychological factors related to kinesiophobia, confidence, and psychological readiness are associated with second ACL injury; however, the evidence is conflicting.

Hypothesis:

Athletes who sustain a second ACL injury (ie, graft rupture or contralateral ACL rupture) within 2 years of ACL reconstruction (ACLR) would have greater kinesiophobia, less confidence, and lower psychological readiness prior to return to sport (RTS) compared with athletes who do not sustain a second ACL injury.

Study Design:

Secondary analysis of a prospective randomized trial.

Level of Evidence:

Level 3.

Methods:

A total of 39 female Level I/II athletes completed the following measures after postoperative rehabilitation and a 10-session RTS and second ACL injury prevention program: ACL Return to Sport after Injury (ACL-RSI) scale, the 11-item Tampa Scale of Kinesiophobia (TSK-11), and question 3 on the Knee injury and Osteoarthritis Outcome Score (KOOS) quality of life (QoL) subscale. Athletes were dichotomized based on whether they sustained a second ACL injury within 2 years of ACLR or not. Independent t tests determined group differences in TSK-11, KOOS-QoL, ACL-RSI, and the 3 individual components of the ACL-RSI (ie, emotions, confidence, risk appraisal).

Results:

Nine athletes sustained a second ACL injury (4 graft ruptures and 5 contralateral ACL ruptures). The group that sustained a second ACL injury had higher scores on the ACL-RSI ( P = 0.03), higher on the risk appraisal questions of the ACL-RSI ( P < 0.01), and met RTS criteria sooner than athletes who did not ( P = 0.04). All second ACL injuries occurred in athletes who underwent primary ACLR with hamstring tendon autografts.

Conclusion:

Athletes who sustained a second ACL within 2 years of ACLR had a more positive psychological outlook, higher scores on the specific questions related to the risk appraisal construct of the ACL-RSI, and met RTS criteria sooner than athletes who did not sustain a second ACL injury.

Clinical Relevance:

Counseling athletes about delaying RTS to reduce the risk of second ACL injury may be especially important in athletes who display high psychological readiness and meet RTS criteria sooner.
Colon capsule retention in a patient with large bowel stenosis due to diverticulosis – a case report
Authors: Schelde-Olesen Benedicte , Rasmussen Benjamin Schnack Brandt , Bjørsum-Meyer Thomas
Published: March 2023

Capsule retention is a rare complication to capsule endoscopy. It is often asymptomatic and resolves itself spontaneously. In some cases, endoscopy or surgery is necessary to remove the capsule. Cases of capsule retention in the colon are not reported very often and precautions in subsequent investigations must be considered. We present a case of a 74-year-old woman who underwent colon capsule endoscopy (CCE) due to a positive fecal immunochemical test. The CCE was incomplete, and the patient was referred to conventional colonoscopy, which was complicated by perforation of the large bowel during the procedure. This lead to a CT scan showing the capsule proximal to a stenotic colon segment which was subsequently surgically removed. In patients who report lack of capsule excretion and stenosis is not verified, colonoscopy can be carried out, but with caution.
The impact of dietary education and counselling with a smartphone application on secondary prevention of coronary artery disease: A randomised controlled study (the TeleDiet study)
Authors: Kaihara Toshiki , Falter Maarten , Scherrenberg Martijn , Xu Linqi , Maes Jana , Meesen Elise , Dendale Paul
Published: March 2023

Objective: In a secondary prevention of coronary artery disease (CAD), nutritional management is an integral part of lifestyle optimisation. However, few studies have investigated the potential of remote nutritional follow-up using digital solutions. This study investigates the effectiveness of a smartphone application for nutrition education and feedback with pictures of meals by a dietitian for patients with CAD. Methods: Sixty participants with CAD were randomised to either a TeleDiet group or a control group. Participants in the TeleDiet group participated in dietary education using a messaging application. The primary outcome was the change of the Mediterranean diet score (MedDietScore). The Nutrition-Score, a modification of the MedDietScore, blood tests (blood lipids, blood glucose and kidney function), body mass index, self-efficacy, medication adherence and health-related quality of life during the observation period were analysed as secondary outcomes. Results: Sixty participants participated in the study. The difference in the MedDietScore in the TeleDiet group was greater than in the control group, but not significant (2.0 [−1.0, 4.0] vs. 0.0 [−3.0, 1.5], p = 0.066). The difference in the Nutrition-Score in the TeleDiet group was significantly greater than in the control group (3.0 [1.0, 3.5] vs. 0.0 [−3.0, 2.0], p = 0.029). Nutrition knowledge of the TeleDiet group improved significantly compared to the control group (1.9 ± 1.7 vs. 0.8 ± 2.1, p = 0.048). Conclusions: A feedback system using a simple messaging application that allows patients with CAD to simply send a picture of their food has a positive effect on nutrition knowledge. It could be a hint for the implementation of the Mediterranean diet.
Artifact removal from sEMG signals recorded during fully unsupervised daily activities
Authors: Costa-García Álvaro , Okajima Shotaro , Yang Ningjia , Shimoda Shingo
Published: March 2023

Objective

In this study, we propose a method for removing artifacts from superficial electromyography (sEMG) data, which have been widely proposed for health monitoring because they encompass the basic neuromuscular processes underlying human motion.

Methods

Our method is based on a spectral source decomposition from single-channel data using a non-negative matrix factorization. The algorithm is validated with two data sets: the first contained muscle activity coupled to artificially generated noises and the second comprised signals recorded under fully unsupervised conditions. Algorithm performance was further assessed by comparison with other state-of-the-art approaches for noise removal using a single channel.

Results

The comparison of methods shows that the proposed algorithm achieves the highest performance on the noise-removal process in terms of signal-to-noise ratio reconstruction, root means square error, and correlation coefficient with the original muscle activity. Moreover, the spectral distribution of the extracted sources shows high correlation with the noise sources traditionally associated to sEMG recordings.

Conclusion

This research shows the ability of spectral source separation to detect and remove noise sources coupled to sEMG signals recorded during unsupervised daily activities which opens the door to the implementation of sEMG recording during daily activities for motor and health monitoring.
Telerehabilitation for musculoskeletal pain – An overview of systematic reviews
Authors: Vieira Ludmilla Maria Souza Mattos de Araújo , de Andrade Marcela Alves , Sato Tatiana de Oliveira
Published: March 2023

Background

Alternative measures for minimizing musculoskeletal pain, such as telerehabilitation, can be implemented in the context of the COVID-19 pandemic.

Objective

The aim of the present overview was to examine evidence from systematic reviews of telerehabilitation for managing musculoskeletal pain.

Methods

This study was conducted following the PRISMA recommendations. Searches were conducted of the Pubmed/Medline, Scopus, Cochrane Library, Web of Science and Embase databases for review articles published from the inception of the database to July 2022. To be included, the studies needed to be a systematic review, include any type of telerehabilitation and present any outcome related to musculoskeletal pain. Studies not available in English were excluded. Theses, dissertations, letters, conference abstracts and narrative reviews were also excluded. The methodological quality of the reviews was appraised using the Assessing the Methodological Quality of Systematic Reviews criteria. Data extraction was performed by two reviewers and included the characterization of the clinical condition and telerehabilitation program, main outcomes, method for appraising the methodological quality of the primary studies, results and quality of evidence.

Results

The search led to the retrieval of 390 potentially eligible studies and 16 systematic reviews were included in this overview. Eleven reviews had meta-analyses and most had high methodological quality. Five of six systematic reviews reported evidence supporting the telehealth intervention for chronic pain conditions; and two of three high-quality systematic reviews reported the absence of evidence for non-specific low back pain.

Conclusions

This overview of systematic reviews enables a better understanding of the characteristics of telerehabilitation programs, provides information for use in clinical practice and describes gaps in the research that need to be filled.
Remnant Preservation of the Primary Vertical Graft in Revision Anterior Cruciate Ligament Reconstruction
Authors: Ahn Jin-Hwan , Son Dong-Wook , Ahn Ji-Hyun , Park Dae-Won , Park Jun-Hyoung
Published: March 2023

Background:

The remnant preservation of a primary vertical graft in revision anterior cruciate ligament reconstruction (ACLR) can benefit anteroposterior stability. However, studies that address this concept are rare.

Purpose:

To evaluate clinical outcomes of remnant preservation of primary vertical graft in revision ACLR.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 74 patients with revision ACLR were included in this retrospective study. Remnant preservation revision ACLR was performed only in patients with primary vertical grafts. The patients were divided into 2 groups according to whether the primary remnant vertical graft was preserved (remnant group; n = 48) or absent or sacrificed (no-remnant group; n = 26). The remnant group was further divided according to the degree of remnant tissue: sufficiently preserved subgroup (graft coverage, ≥50%; n = 25) and insufficiently preserved subgroup (graft coverage, <50%; n = 23). Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) subjective form, Lysholm score, Tegner activity scale, manual laxity tests, and side-to-side difference in anterior tibial translation on Telos stress radiographs.

Results:

The mean time to final follow-up was 40.7 ± 16.8 months. The remnant group showed more improved results in the postoperative Lachman test and Telos side-to-side difference than did the no-remnant group ( P = .017 and .016, respectively). The post hoc test revealed that the side-to-side difference in laxity in the sufficiently preserved subgroup significantly outperformed that in the no-remnant group ( P = .001), although no significant difference existed between the insufficiently preserved and no-remnant subgroups ( P = .850). The postoperative IKDC subjective form, Lysholm score, and Tegner activity scale did not show significant differences between the 2 groups ( P = .480, .277, and .883, respectively).

Conclusion:

The remnant preservation of the primary vertical graft in revision ACLR may result in better anteroposterior stability. However, subjective outcomes in the remnant group did not exceed that of the no-remnant group. The subgroup analysis revealed that only sufficiently preserved remnants demonstrated better anteroposterior stability.
Explaining Novice Nurses’ Experience of Weak Professional Confidence: A Qualitative Study
Authors: Najafi Bahareh , Nasiri Ahmad
Published: March 2023

Introduction

The majority of newly graduated nurses are not prepared to work at the bedside; therefore, they may not have the appropriate self-confidence.

Objective(s)

The present qualitative study aimed to explain the novice nurses’ experience of weak professional confidence.

Design

This qualitative study was performed using a content analysis method.

Methods

Content analysis was utilized to identify themes from interview transcripts. They were included in the study by purposeful sampling. Participants were interviewed through face-to-face and unstructured interviews. All data were recorded, transcribed, and analyzed based on the Graneheim and Lundman method.

Results

Thirteen nurses participated in interviews. After data collection, all interviews were implemented and reviewed and the categories and subcategories were extracted. Three main categories containing turbulence in working life, unpleasant interactions, and lack of knowledge were extracted.

Conclusion

According to the study findings, most novice nurses experienced turbulence in their working life, unpleasant interactions, and a lack of knowledge that affected their self-confidence. Therefore, educational and support programs are suggested to improve novice nurses’ professional confidence.

Relevance to Clinical Practice

According to the results of the study, the lack of self-confidence in novice nurses reduces the quality of care. Therefore, taking into account the experiences of the participants, nursing education managers should plan in such a way as to improve the self-confidence of the graduates. In addition, novice nurses need to be supported by their managers and colleagues to develop their professional confidence to provide more effective care.
Bisphosphonate versus non-bisphosphonate treatment for hypercalcemia of malignancy in patients with renal dysfunction
Authors: Khouderchah Christy J , Nachar Victoria R , McDevitt Rachel L , Schepers Allison J
Published: March 2023

Background:

Bisphosphonates are the backbone of treatment for hypercalcemia of malignancy (HCM). However, concern regarding their safety in patients with renal dysfunction exists. The safety and effectiveness of bisphosphonates compared to other treatment options for HCM in the setting of renal dysfunction have not been evaluated.

Methods:

A retrospective cohort analysis of adult patients with HCM and renal dysfunction defined as a creatinine clearance (CrCl) <60 mL/min who received front-line bisphosphonate versus non-bisphosphonate therapy from 1/2015 to 4/2021 was conducted. The primary endpoint was the incidence of all-grade serum creatinine (SCr) elevation from baseline by day 30 from initial HCM-directed therapy. A multivariate logistic regression was conducted to examine predictors of worsening renal function.

Results:

Of 129 patients, 111 (86%) patients received bisphosphonates and 18 (14%) received non-bisphosphonate first-line HCM-directed therapy. All-grade SCr elevation occurred similarly between bisphosphonate and non-bisphosphonate groups, 27.9% versus 27.8% respectively ( p = 0.99). Receipt of bisphosphonates did not significantly impact the incidence of all-grade SCr elevation ( p = 0.195) while chronic kidney disease (CKD) at baseline did ( p = 0.003).

Conclusions:

Bisphosphonates appear to be as safe as non-bisphosphonate therapy in patients with baseline renal dysfunction for the treatment of HCM.
Surveillance Endoscopy After Foregut Surgery: Is It Necessary?
Authors: Alwatari Yahya , Scheese Daniel , Gardner Graham , Vudatha Vignesh , Julliard Walker , Puig Gilbert Carlos , Shah Rachit D.
Published: March 2023

Patients undergoing foregut surgeries can have de novo findings or worsening of underlying upper gastrointestinal pathologies including Barrett’s esophagus and gastric intestinal metaplasia. These changes carry a potentially increased risk for malignancy development in the future raising the question of the utility of post-operative surveillance endoscopy after esophagectomy, bariatric and metabolic surgeries (Sleeve gastrectomy and Roux-en-Y Gastric Bypass), achalasia treatment, and anti-reflux surgery. In this narrative review, we conduct a literature exploration of available data on post-operative endoscopic surveillance findings following the procedures summarizing the prevalence of upper gastrointestinal pathologies and recommendations on the utility of postoperative endoscopy from established medical societies.
A framework for measuring the cost to families of caring for children’s health: the design, methodology, and study population of the r-Kids study
Authors: Bulkley Joanna E. , Varga Alexandra M. , Dickerson John F. , Crawford Phil , Croen Lisa A. , Daida Yihe G. , Fombonne Eric , Hatch Brigit , Lee April , Massolo Maria , Vaughn Katherine , Lynch Frances L.
Published: March 2023

Background

All families experience financial and time costs related to caring for their children’s health. Understanding the economic burden faced by families of children with chronic health conditions (CHC) is crucial for designing effective policies to support families.

Methods

In this prospective study we used electronic health records to identify children between 3 and 17 years old with autism spectrum disorder (ASD), asthma, or neither (control) from three Kaiser Permanente regions and several community health centers in the OCHIN network. We oversampled children from racial and ethnic minority groups. Parent/guardian respondents completed surveys three times, approximately four months apart. The surveys included the Family Economic Impact Inventory (measuring financial, time, and employment costs of caring for a child’s health), and standardized measures of children’s quality of life, behavioral problems, and symptom severity for children with ASD or asthma. We also assessed parenting stress and parent physical and mental health. All materials were provided in English and Spanish.

Results

Of the 1,461 families that enrolled (564 ASD, 468 asthma, 429 control), children were predominantly male (79%), with a mean age of 9.0 years, and racially and ethnically diverse (43% non-Hispanic white; 22% Hispanic; 35% Asian, Black, Native Hawaiian, or another race/ethnicity). The majority of survey respondents were female (86%), had a college degree (62%), and were married/partnered (79%). ASD group respondents were less likely to be employed (73%) than those in the asthma or control groups (both 80%;p = .023). Only 32% of the control group reported a household income ≤ $4,000/month compared with 41% of asthma and 38% of ASD families (p = .006).

Conclusions

Utilizing a novel measure assessing family economic burden, we successfully collected survey responses from a large and diverse sample of families. Drawing upon the conceptual framework, survey measures, and self-report data described herein we will conduct future analyses to examine the economic burdens related to CHC and the incremental differences in these burdens between health groups. This information will help policy makers to design more equitable health and social policies that could reduce the burden on families.
Community coalition efforts to prevent childhood obesity: two-year results of the Shape Up Under 5 study
Authors: Economos Christina D. , Calancie Larissa , Korn Ariella R. , Allender Steven , Appel Julia M. , Bakun Peter , Hennessy Erin , Hovmand Peter S. , Kasman Matt , Nichols Melanie , Pachucki Mark C. , Swinburn Boyd A. , Tovar Alison , Hammond Ross A.
Published: March 2023

Background

Cross-sector collaborations and coalitions are promising approaches for childhood obesity prevention, yet there is little empirical evidence abouthowthey affect change. We hypothesized that changes in knowledge of, and engagement with, childhood obesity prevention among coalition members can diffuse through social networks to influence policies, systems, and environments.

Methods

We studied a community coalition (N = 16, Shape Up Under 5 “SUU5 Committee”) focused on early childhood obesity prevention in Somerville, MA from 2015–17. Knowledge, engagement, and social network data were collected from Committee members and their network contacts (n = 193) at five timepoints over two years. Policy, systems, and environment data were collected from the SUU5 Committee. Data were collected via the validated COMPACT Stakeholder-driven Community Diffusion survey and analyzed using regression models and social network analysis.

Results

Over 2 years, knowledge of (p = 0.0002), and engagement with (p = 0.03), childhood obesity prevention increased significantly among the SUU5 Committee. Knowledge increased among the Committee’s social network (p = 0.001). Significant changes in policies, systems, and environments that support childhood obesity prevention were seen from baseline to 24 months (p = 0.003).

Conclusion

SUU5 had positive effects on “upstream” drivers of early childhood obesity by increasing knowledge and engagement. These changes partially diffused through networks and may have changed “midstream” community policies, systems, and environments.
Treatment of septic shock in two pediatric patients with severe diabetic ketoacidosis using invasive hemodynamic monitoring: a case report
Authors: Saeed Amir , Ziyaee Fateme
Published: March 2023

Background

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus. DKA associated with shock is a rare condition that occurs due to the fluid deficit or septic shock. It is not easy to differentiate these two conditions by clinical judgment and laboratory findings. Although the fluid therapy is the mainstay in DKA treatment, it looks like a double-edged sword—underhydration may result in organ failure whereas overhydration may lead to pulmonary and cerebral edema (CE).

Case presentation

Herein, we report on two pediatric patients presenting with DKA and septic shock. The first patient was an 8-year-old boy newly diagnosed with type 1 diabetes mellitus (T1DM) who presented with DKA and septic shock. We used a device for continuous hemodynamic monitoring (proAQT) to estimate his volume status. The patient was extubated 48 hours of hospitalization; the DKA was resolved after 52 hours of admission. He was discharged home in good condition on the 5th day. The second patient was a 13-year-old girl, a known case of T1DM, who presented with mixed DKA- hyperosmolar-hyperglycemic state (HHS) and septic shock. She was intubated and treated according to the data derived from pulse Contour Cardiac Output (PiCCO). After 3 days, she was extubated and transferred to the ward in good condition.

Conclusion

Using invasive hemodynamic monitoring in critically ill children with severe DKA and hypotension might guide the physicians for hydration and selecting the most appropriate inotrope.