bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the needs and uses for drones in medical emergencies in England and Scotland: a survey of emergency healthcare workers
Authors: Théorêt Olivia , Barrack Sophie , Morgan Heather May
Published: October 2022

Background

The application of drones in healthcare is a new concept being introduced in various countries to fly medical supplies. Public perceptions have been investigated but the perceptions of healthcare professionals on the frontline have not been explored. This study examined the perceptions of emergency care providers in England and Scotland to determine how they believe drones could be used when providing emergency care.

Methods

Frontline healthcare professionals were surveyed regarding their perceptions of drones in emergency medical scenarios. A survey with 27 questions built on SNAP 11 was published on social media for participant recruitment.

Results

Thematic analysis yielded insights into what healthcare professionals believe should be flown in an emergency notably: blood, defibrillators, and medication. Drones are perceived to be beneficial for life-threatening scenarios (high-risk, time-critical, trauma, search, and rescue applications) and routine medical care such as delivery of medical supplies and minor interventions. 100% of participants believed that providing medical care could benefit from a drone flying to a remote area or directly to a patient. 76% believed that having a drone fly key medical equipment faster could change the outcome of a patient. Scepticism regarding regulations and logistics involved, as well as concern for drone-based medical care, were identified by participants.

Conclusion

Drone use in healthcare remains an immature field and this study confirms that this domain warrants further research. It is key to remember that the perspectives of those impacted by the integration of drones will have to be explored to guide the application.
Impact of a vaccine passport on first-dose COVID-19 vaccine coverage by age and area-level social determinants in the Canadian provinces of Québec and Ontario: an interrupted time series analysis
Authors: Flores Anato Jorge Luis , Ma Huiting , Hamilton Mackenzie A. , Xia Yiqing , Harper Sam , Buckeridge David , Brisson Marc , Hillmer Michael P. , Malikov Kamil , Kerem Aidin , Beall Reed , Baral Stefan , Dubé Ève , Mishra Sharmistha , Maheu-Giroux Mathieu
Published: October 2022

Background

In Canada, all provinces implemented vaccine passports in 2021 to increase vaccine uptake and reduce transmission in non-essential indoor spaces. We evaluate the impact of vaccine passport policies on first-dose COVID-19 vaccination coverage by age, area-level income and proportion racialized.

Methods

We performed interrupted time-series analyses using vaccine registry data linked to census information in Québec and Ontario (20.5 million people ≥12 years; unit of analysis: dissemination area). We fit negative binomial regressions to weekly first-dose vaccination, using a natural spline to capture pre-announcement trends, adjusting for baseline vaccination coverage (start: July 3rd; end: October 23rdQuébec, November 13thOntario). We obtain counterfactual vaccination rates and coverage, and estimated vaccine passports’ impact on vaccination coverage (absolute) and new vaccinations (relative).

Results

In both provinces, pre-announcement first-dose vaccination coverage was 82% (≥12 years). The announcement resulted in estimated increases in vaccination coverage of 0.9 percentage points (p.p.;95%CI:0.4-1.2) in Québec and 0.7 p.p. (95%CI:0.5-0.8) in Ontario. In relative terms, these increases correspond to 23% (95%CI:10-36%) and 19% (95%CI:15-22%) more vaccinations. The impact was larger among people aged 12-39 (1-2 p.p.). There was little variability in the absolute impact by area-level income or proportion racialized in either province.

Conclusions

In the context of high baseline vaccine coverage across two provinces, the announcement of vaccine passports led to a small impact on first-dose coverage, with little impact on reducing economic and racial inequities in vaccine coverage. Findings suggest the need for other policies to further increase vaccination coverage among lower-income and more racialized neighbourhoods and communities.

Key messages

Vaccine passport policies increased COVID-19 vaccination coverage by approximately 1 percentage point (19 to 23% increase in vaccinations) in Québec and Ontario, Canada.

Although vaccine passport policies increased vaccination coverage, absolute gains were limited in the context of high prior vaccine coverage.

Vaccine passports had little impact on reducing economic and racial inequities in vaccine coverage.
Identifying vaccine-mechanism bias in mathematical models of vaccine impact: the case of tuberculosis
Authors: Tovar M. , Moreno Y. , Sanz J.
Published: October 2022

In the development of vaccines against tuberculosis (TB), a number of factors represent burdensome difficulties for the design and interpretation of randomized control trials (RCTs) of vaccine efficacy. Among them, the complexity of the transmission chain of TB allows the co-existence of several routes to disease that can be observed within the populations from where vaccine efficacy trial participants are sampled. This makes it difficult to link trial-derived readouts of vaccine efficacy to specific vaccine mechanistic descriptions, since, intuitively, the same efficacy readouts may lean on the ability of a vaccine to arrest only some, but not all, the possible routes to disease. This increases uncertainty in evaluations of vaccine impact based on transmission models, since different vaccine descriptions of the same efficacy readout typically lead to different impact forecasts. In this work, we develop a Bayesian framework to evaluate the relative compatibility of different vaccine descriptions with the observations emanating from a randomized clinical trial (RCT) of vaccine efficacy, offering an unbiased framework to estimate vaccine impact even when the specific mechanisms of action of the given vaccine are not explicitly known. The type of RCTs considered here, conducted on IGRA+ individuals, emerged as a promising design architecture after the encouraging results reported for the vaccine M72/AS01Eclinical trial, which we use here as a case study.

Authors summary

Here, we focus on a problem that is pervasive in mathematical modeling of vaccines’ impact, consisting of the existence of a multiplicity of vaccine parametrizations that are compatible with the result of a given clinical trial of vaccine efficacy. However, focusing on tuberculosis vaccines, we find that it is possible to use computational simulations and Bayesian statistics to assign these models with posterior probabilities measuring their relative compatibility with the results of a real clinical trial under analysis. The framework presented unlocks the production of unbiased, mechanism-agnostic impact forecasts for vaccines against tuberculosis, and can be extended to the study of vaccines against other communicable diseases with a complex infectious cycle.
Persistence of spore-formingClostridium(Clostridioides)difficilethrough wastewater treatment plants in Western Australia
Authors: Chisholm Jessica M. , Putsathit Papanin , Riley Thomas V. , Lim Su-Chen
Published: October 2022

There is growing evidence that showsClostridium(Clostridioides)difficileis a pathogen of One Health importance with a complex dissemination pathway involving animals, humans and the environment. Thus, environmental discharge and agricultural recycling of human and animal waste have been suspected as factors behind the dissemination ofC. difficilein the community. Here, the presence ofC. difficilein 12 wastewater treatment plants (WWTPs) in Western Australia was investigated. Overall,C. difficilewas found in 90.5% (114/126) of raw sewage influent, 48.1% (50/104) of treated effluent, 40% (2/5) of reclaimed irrigation water, 100% (38/38) of untreated biosolids, 95.2% (20/21) of anaerobically digested biosolids and 72.7% (8/11) of lime-amended biosolids. Over half the isolates (55.3%, 157/284) were toxigenic and 97C. difficileribotypes (RTs) were identified with RT014/020 the most common (14.8%, 42/284). ThirteenC. difficileisolates with the toxin profile A+B+CDT+ were found, including the hypervirulent RT078 strain. Resistance to the antimicrobials fidaxomicin, vancomycin, metronidazole, rifaximin, amoxicillin/clavulanate, meropenem and moxifloxacin was uncommon, however, resistance to clindamycin, erythromycin and tetracycline was relatively frequent at 56.7% (161/284), 14.4% (41/284) and 13.7% (39/284), respectively. This study revealed that toxigenicC. difficilewas commonly encountered in WWTPs and being released into the environment. This raises concern about the possible spill-over ofC. difficileinto animal and/or human populations via land receiving the treated waste. In Western Australia, stringent measures are in place to mitigate the health and environmental risk of recycling human waste, however, further studies are needed to elucidate the public health significance ofC. difficilesurviving the treatment processes at WWTPs.

IMPORTANCE

Clostridium difficileinfection (CDI) is a leading cause of antimicrobial-associated diarrhoea in healthcare facilities. Extended hospital stays and recurrences increase the cost of treatment, and morbidity and mortality. Community-associated CDI (CA-CDI) cases, with no history of antimicrobial use or exposure to healthcare settings, are increasing. The isolation of clinically importantC. difficilestrains from animals, rivers, soil, meat, vegetables, compost, treated wastewater and biosolids has been reported. The objective of this study was to characteriseC. difficilein wastewater treatment plants (WWTPs) in Australia. We found thatC. difficilecan persist through the treatment processes of WWTPs and toxigenicC. difficilewas being released into the environment becoming a potential source/reservoir for CA-CDI.
Disentangling the dynamics of energy allocation to provide a proxy of robustness in fattening pigs
Authors: Lenoir Guillaume , Flatres-Grall Loïc , Muñoz-Tamayo Rafael , David Ingrid , Friggens Nicolas C.
Published: October 2022

Background

There is a growing need to improve robustness characteristics in fattening pigs, but this trait is difficult to phenotype. Our first objective was to develop a robustness proxy on the basis of modelling of longitudinal energetic allocation coefficient to growth for fattening pigs. Consequently, the environmental variance of this allocation coefficient was considered as a proxy of robustness. The second objective was to estimate its genetic parameters and correlation with traits under selection as well with phenotypes routinely collected on farms. A total of 5848 pigs, from Piétrain NN paternal line, were tested at the AXIOM boar testing station (Azay-sur-Indre, France) from 2015 to 2022. This farm was equipped with automatic feeding system, recording individual weight and feed intake at each visit. We used a dynamic linear regression model to characterize the evolution of the allocation coefficient between cumulative net energy available, estimated from feed intake, and cumulative weight gain during fattening period. Longitudinal energetic allocation coefficients were analysed using a two-step approach, to estimate both its genetic variance and the genetic variance in the residual variance, trait LSR.

Results

The LSR trait, that could be interpreted as an indicator of the response of the animal to perturbations/stress, showed low heritability (0.05±0.01). The trait LSR had high favourable genetic correlations with average daily growth (−0.71±0.06) and unfavourable with feed conversion ratio (−0.76±0.06) and residual feed intake (−0.83±0.06). The analysis of the relationship between estimated breeding values (EBV) LSR quartiles and phenotypes routinely collected on farms shows the most favourable situation for animals from quartile with the weakest EBV LSR,i.e., the most robust.

Conclusions

These results show that selection for robustness based on deviation from energetic allocation coefficient to growth can be considered in breeding programs for fattening pigs.
How Cerebellar Architecture and Dense Activation Patterns Facilitate Online Learning in Dynamic Tasks
Authors: Perez Rotondo Adriana , Raman Dhruva V. , O’Leary Timothy
Published: October 2022

Summary

The cerebellum has a distinctive architecture in which inputs undergo a massive size expansion in dimensionality in early layers. Marr and Albus’s classic codon theory and more recent extensions1–4argue that this architecture facilitates learning via pattern separation. The essence of this idea is that sparsely active clusters —‘codons’— of inputs are more easily separable in a higher dimensional representation. However, recent physiological data indicate that cerebellar activity is not sparse in the way anticipated by codon theory. Moreover, there is a conceptual gap between static pattern separation and the critical role of the cerebellum in dynamic tasks such as motor learning. We use mathematical analysis and simulations of cerebellar learning to identify specific difficulties inherent to online learning of dynamic tasks. We find that size expansions directly mitigate these difficulties, and that this benefit is maximised when granule cell activity is dense.
Myelination and excitation-inhibition balance synergistically shape structure-function coupling across the human cortex
Authors: Fotiadis Panagiotis , Cieslak Matthew , He Xiaosong , Caciagli Lorenzo , Ouellet Mathieu , Satterthwaite Theodore D. , Shinohara Russell T. , Bassett Dani S.
Published: October 2022

Recent work has demonstrated that the relationship between structural and functional connectivity varies regionally across the human brain, with reduced coupling emerging along the sensory-association cortical hierarchy. The biological underpinnings driving this expression, however, remain largely unknown. Here, we postulated that intracortical myelination and excitation-inhibition (EI) balance mediate the heterogeneous expression of structure-function coupling (SFC) and its temporal variance across the cortical hierarchy. We employed atlas-and voxel-based connectivity approaches to analyze neuroimaging data acquired from two groups of healthy participants. Our findings were consistent across processing pipelines: 1) increased myelination and lower EI-ratio associated with more rigid SFC and restricted moment-to-moment SFC fluctuations; 2) a gradual shift from EI-ratio to myelination as the principal predictor of SFC occurred when traversing from granular to agranular cortical regions. Collectively, our work delivers a novel framework to conceptualize structure-function relationships in the human brain, paving the way for an improved understanding of how demyelination and/or EI-imbalances induce reorganization in brain disorders.
Streptococcus agalactiae npxis required for survival in human placental macrophages and full virulence in a model of ascending vaginal infection during pregnancy
Authors: Lu Jacky , Moore Rebecca E. , Spicer Sabrina K. , Doster Ryan S. , Guevara Miriam A. , Francis Jamisha D. , Noble Kristen N. , Rogers Lisa M. , Talbert Julie A. , Korir Michelle L. , Townsend Steven D. , Aronoff David M. , Manning Shannon D. , Gaddy Jennifer A.
Published: October 2022

Streptococcus agalactiae, also known as Group BStreptococcus(GBS), is a Gram- positive encapsulated bacterium that colonizes the gastrointestinal tract of 30-50% of humans. GBS causes invasive infection during pregnancy that can lead to chorioamnionitis, funisitis, preterm prelabor rupture of membranes (PPROM), preterm birth, neonatal sepsis, and maternal and fetal demise. Upon infecting the host, GBS encounters sentinel innate immune cells, such as macrophages, within reproductive tissues. Once phagocytosed by macrophages, GBS upregulates expression of the gene,npx, which encodes a NADH peroxidase. GBS mutants with anpxdeletion (Δnpx) are exquisitely sensitive to reactive oxygen stress. Furthermore, we have shown thatnpxis required for GBS survival in both THP-1 and placental macrophages. In anin vivomurine model of ascending GBS vaginal infection during pregnancy,npxis required for invasion of reproductive tissues and is critical for inducing disease progression including PPROM and preterm birth. Reproductive tissue cytokine production was also significantly diminished in Δnpxinfected animals compared to those infected with wild type (WT)-GBS. Complementationin transreversed this phenotype, indicatingnpxis critical for GBS survival and initiation of proinflammatory signaling in the gravid host.
Digitalization adoption for digital economy: an examination of Malaysian small medium-sized enterprises through the technology–organization–environment framework
Authors: Low Mei Peng , Seah Choon Sen , Cham Tat-Huei , Teoh Sian Hoon
Published: October 2022

Purpose

This research is set to assess the achievement of digital economy through digitalization adoption (DA) among Small Medium-sized Enterprises (SMEs). For more insightful findings, a comparison between the service-based and non-service-based industries was performed. Besides, it endeavours to identify the important and performing dimension of the Technology-Organization-Environment (TOE) framework. The purpose of this paper is to address these issues.

Design/methodology/approach

Quantitative approach through purposive sampling technique was used to collect data from the SMEs. Variance-based structural equation modeling was adopted to assess the model and multi-group analysis (MGA) was executed to examine the difference between the two classified industries. For the identification of the dimension, Importance-Performance Map Aanalysis (IPMA) was carried out.

Findings

Technology and organization recorded significant positive influence on digitalization adoption but not environment. Digitalization adoption between the two classified industries shows divergent results. IPMA concur the importance and performance of the technology and organization dimension, in which SMEs shall focus on for digitalization adoption.

Research limitations/implications

This is cross sectional research and data were collected at a single time frame. Hence, the result is a state-or-art finding. Assuming that if there are changes in government policies, the results may differ. Besides, there are other possible groupings that could affect the results in which is not covered in the present research.

Practical implications

The findings imply that the DA amongst SMEs has yet to achieve its full spectrum, which indicates Malaysia has yet to fully embrace digital economy. Nevertheless, DA is the fundamental for a successful digital economy.

Social implications

This research provides the general public an overview that SMEs are adopting digitalization with various degree. This specifies that the society is paving towards digitalization with the SMEs actively adopting more digital technologies.

Originality/value

The novelty of this research arises from the utilization of the TOE framework to link to the achievement of the national digital economy. Additionally, current research adopted a rigorous approach to investigate the issue by using MGA, the hierarchical component model (HCM) and IPMA for holistic findings.
Transforming self-perceived self-employability and entrepreneurship among mothers through mobile digital sharing economy platforms: an exploratory case study
Authors: Seet Pi-Shen , Jogulu Uma , Cripps Helen , Nejati Mehran
Published: October 2022

Purpose

This research focuses on the extent sharing economy transforms employability for women impacted by domestic and reproductive work. The authors explore the experience of mothers, of how digital peer-to-peer (P2P) platforms can affect their self-perceived employability and skills deterioration by unlocking human capital through technology acceptance.

Design/methodology/approach

This study adopted a pragmatism-based approach incorporating using a single-case study research design with the Gioia methodology. It utilised a semi-structured telephone survey to collect data to explore the decisions around usage of a newly developed mobile P2P app, aiming to support employability among mothers. Analysis was conducted inductively using thematic analysis and partial least squares structural equation modelling (PLS-SEM).

Findings

The study finds that mothers experience high rates of continued labour market attachment on a casual or part-time basis, difficulty in juggling family and work, and high levels of concern both about future employment/entrepreneurial opportunities and expected stress in balancing dual roles of carer and earner. While mothers are interested in using new sharing economy technologies to reduce skills deterioration and improve signalling, the authors find that there were both technology and non-technology related barriers. These included trust and security, life-stage mismatch, time poverty and limitation of service offerings.

Research limitations/implications

This research was limited to mothers in one state in Australia and by the case study research design, the measurement model and the self-report nature of the data collection. Hence, the findings may lack generalisability in other contexts. It also limits the ability to make conclusions regarding causality.

Originality/value

This exploratory study contributes to research in the intersection between human resources (HR) and entrepreneurship by illustrating how sharing economy platforms can offer women a means to overcome the issues of signalling and skills deterioration in relation to aspects of human capital theory by developing new skills that may act as positive signals signal to potential employers or investors. Additionally, the social interactions between mothers, through technology adoption, can provide a basis for improving future self-employment or entrepreneurship and employability.
Conclusion: how could rural tourism provide better support for well-being and socioeconomic development?
Authors: Singh Ardhendu Shekhar , Parahoo Sanjai K. , Ayyagari Madhavi , Juwaheer Thanika Devi
Published: October 2022

Purpose

This concluding paper summarizes the articles presented in this issue and the significant themes that emerged from the authors' contributions. The main objective of this theme issue on rural tourism is to examine different facets of rural tourism that are critical to short-term recovery as well as long-term sustainable development.

Design/methodology/approach

This article draws on the findings of the papers and revisits the question: how could rural tourism provide better support for well-being and socioeconomic development?

Findings

The papers in this issue can be classified into one of three clusters: (1) cultural traditions; (2) support for rural tourism service providers and (3) embracing new technologies. In addition to classifying these papers, the authors propose a conceptual framework to achieve sustainable rural tourism and development comprising four critical success factors for sustainable rural tourism and development.

Originality/value

The main objective of this theme issue is to examine different facets of rural tourism that are critical to short-term recovery as well as long-term sustainable development. Here the authors summarize the findings and propose a conceptual model for the benefit of managers. The authors think that the model could be helpful in designing a strategy for developing sustainable rural tourism projects. It includes reference to (1) stakeholder engagement and support for capacity-building, (2) gradual and organic growth processes, (3) valorization of sociocultural traditions and preservation of cultural heritage and (4) leveraging digital technology in marketing strategy.
A field test of mechanisms underpinning animal diversity in recently burned landscapes
Authors: Senior Katharine L. , Giljohann Katherine M. , McCarthy Michael A. , Kelly Luke T.
Published: October 2022

Planned burning generates different types of pyrodiversity, however, experimental tests of how alternative spatial patterns of burning influence animal communities remain rare. Field tests are needed to understand the mechanisms through which spatial variation in planned fire affects fauna, and how fire can be applied to benefit biodiversity.

We tested five hypotheses of how fire‐driven variation in habitat composition and configuration affects fauna at fine scales. Small mammal, reptile and invasive predator activity was monitored at 12 burnt and eight unburnt sites through the year following a large, planned burn in semi‐arid ‘mallee’ woodlands of southern Australia. We explored measures of burnt or unburnt habitat (‘habitat status’); amount of unburnt vegetation (‘habitat amount’); interspersion of burnt and unburnt patches (‘habitat complementation’); distance to external or internal unburnt vegetation (‘habitat connectivity’); and unburnt patch size and local vegetation cover (‘habitat refuge’). Generalized linear models were used to test the influence of each variable on capture rates of three small mammal and 11 reptile species; activity of the introduced red fox (Vulpes vulpes); and species richness of native animals.

We found strong support for the habitat status hypothesis and moderate support for four hypotheses relating to spatial patterns of fire. Reptile assemblages varied between burnt and unburnt sites, and relationships were identified between abundance of one or more reptile species and each measure of spatial variation. Reptile species richness was higher at unburnt sites and at sites with more unburnt vegetation in the surrounding area. Sites that were less connected to unburnt vegetation had fewer reptile species. Mammals did not have clear relationships with fine‐scale fire patterns.

Synthesis and applications. Application of planned fire to promote biodiversity is globally important. We show that retaining unburnt areas and well‐connected habitat refuges is important for reptile diversity. We also found that several species of small mammals and reptiles appear resilient to the fine‐scale patterns of planned fire experienced in this study, despite activity of introduced predators. The diversity of animals can remain relatively high in areas subject to planned fire, provided that internal and external habitat refuges are retained.
Higher‐latitude spring‐flowering herbs advance their phenology more than trees with warming temperatures
Authors: Alecrim Evelyn F. , Sargent Risa D. , Forrest Jessica R. K.
Published: October 2022

The phenologies of co‐occurring trees and spring‐blooming understory herbs in northeastern North American hardwood forests appear to be regulated by different environmental drivers – air temperature and soil temperature/snowpack, respectively. Accordingly, it has been hypothesized that climate change–driven asymmetry in the advancement of canopy leaf‐out relative to the timing of understory growth could reduce photosynthetic rates and reproductive success of understory herbs through greater early‐season shading.

To determine whether trees and spring‐flowering forest herbs are advancing their phenologies at different rates with respect to increasing global temperatures, we examined the phenological responses to warming of 10 species of trees and 11 species of spring‐flowering forest herbs (8045 observations from 965 sites) in northeastern North America using 13 years of data collected by citizen scientists under the auspices of the USA‐National Phenology Network.

Contrary to expectation, the degree of advancement of leaf‐out as a function of temperature was greater in spring‐flowering forest herbs than in trees, with a mean response rate of −4.9 days/°C (95% BCI [−5.2, −4.6]) for spring‐flowering forest herbs vs. −3.3 days/°C (95% BCI [−3.5, −3.1]) for trees. However, the response to temperature was not consistent across the latitudinal range, with spring‐flowering forest herbs responding more strongly to warming than trees at middle (40–44°N) and higher (45–48°N) latitudes but not at lower latitudes (35–39°N).

Synthesis. In contrast to previous suggestions, our study shows spring‐flowering forest herbs advancing their phenology at a higher rate than trees with respect to warming through most of the latitudinal range investigated, which could translate into a longer growing season and increased carbon uptake for spring‐flowering forest herbs as spring temperatures rise.
‘The unbearable surplus of being human’: Happiness, virtues and the delegitimisation of the negative
Authors: Hodgson Naomi
Published: October 2022

The increased governmental focus on happiness since the late 1990s, and particularly since the economic crash of 2008, has been informed predominantly by a conceptualisation of happiness promoted by the field of positive psychology, and adopted and developed in fields such as behavioural economics and more recently in fields such as neuroeducation. Concepts, or traits, associated with feeling happy or satisfied with our lives, such as resilience, are now promoted across both public and private domains as a means to improve our quality of life, our productivity and our attainment. The promotion of this positive psychological notion of happiness in the context of education not only presents these traits as virtues of the productive learning citizen but also effects a delegitimisation of the negative. Analysis of curricula programmes, seen alongside the shift taken towards a focus on the individual as brain, highlights the pedagogical and political implications of this.
Nursing interventions and activities for patients with multiple traumas: An integrative review
Authors: Camilo Ferreira Ráisa , Moorhead Sue Ann , Zuchatti Bruna Valentina , Correia Marisa Dibbern Lopes , Montanari Fabio Luis , Duran Erika Christiane Marocco
Published: October 2022

Purpose

The purpose of this study was to identify nursing interventions and activities for patients with multiple traumas who have variations in physical mobility.

Methods

We used integrative literature review following Whittemore and Knafl method and the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses’ guidelines and adopting the Oxford Center for Evidence‐Based Classification Medicine – Levels of Evidence. The data collection was carried out between October and December 2019 and updated in May 2022, in the following databases: Virtual Health Library, Cochrane Library, Excerpta Medica dataBASE, Medical Literature Analysis and Retrieval System Online, PubMed®, SciVerse Scopus, The Cumulative Index to Nursing and Allied Health Literature, and Web of Science.

Findings

There were 103 articles to be fully read and evaluated. From these, 34 publications were selected. Most nursing interventions and activities identified were placed in the NIC class Activity and Exercise Management in the Physiological: Basic domain, which has interventions to organize or to assist with physical activity, energy conservation, and expenditure; followed by Elimination Management (interventions to establish and maintain regular bowel and urinary elimination patterns and manage complications due to altered patterns); Immobility Management (interventions to manage restricted body movement and the sequelae); Nutrition Support (interventions to modify or maintain nutritional status); Physical Comfort Promotion (interventions to promote comfort using physical techniques); and Self‐Care Facilitation (interventions to provide or assist with routine activities of daily living).

Conclusions

The interventions and nursing activities found in this research were not only related to the change in mobility in victims of multiple traumas but also aimed to prevent the consequences of immobility and to take care of already established conditions.

Implications for the nursing practice

This research enables the taxonomy's development and the validation of interventions for selected groups of patients. This allows the contribution to the development of the NIC—an important resource to improve nursing practice in teaching, research, and care.
Continuous wireless pre‐ and postoperative vital sign monitoring reveal new, severe desaturations after vascular surgery
Authors: Mølgaard Jesper , Rasmussen Søren Straarup , Eiberg Jonas , Sørensen Helge Bjarup Dissing , Meyhoff Christian Sylvest , Aasvang Eske Kvanner
Published: October 2022

Objectives

Postoperative deviating physiologic values (vital signs) may represent postoperative stress or emerging complications. But they can also reflect chronic preoperative values. Distinguishing between the two circumstances may influence the utility of using vital signs in patient monitoring. Thus, we aimed to describe the occurrence of vital sign deviations before and after major vascular surgery, hypothesising that preoperative vital sign deviations were longer in duration postoperatively.

Methods

In this prospective observational study, arterial vascular patients were continuously monitored wirelessly ‐ from the day before until 5 days after surgery. Recorded values were: heart rate, respiration rate, peripheral arterial oxygen saturation (SpO2) and blood pressure. The outcomes were 1. cumulative duration of SpO2 < 85% / 24 h, and 2. cumulative duration per 24 h of vital sign deviations.

Results

Forty patients were included with a median monitoring time of 21 h preoperatively and 42 h postoperatively. The median duration of SpO2 < 85% preoperatively was 14.4 min/24 h whereas it was 28.0 min/24 h during day 0 in the ward (p = .09), and 16.8 min/24 h on day 1 in the ward (p = 0.61). Cumulative duration of SpO2 < 80% was significantly longer on day 0 in the ward 2.4 min/24 h (IQR 0.0–4.6) versus 6.7 min/24 h (IQR 1.8–16.2) p = 0.01.

Conclusion

Deviating physiology is common in patients before and after vascular surgery. A longer duration of severe desaturation was found on the first postoperative day in the ward compared to preoperatively, whereas moderate desaturations were reflected in postoperative desaturations. Cumulative duration outside thresholds is, in some cases, exacerbated after surgery.
How the Party Commands the Gun: The Foreign–Domestic Threat Dilemma in China
Authors: Mattingly Daniel C.
Published: October 2022

The leaders of authoritarian states face a dilemma between building a loyal military to guard against domestic threats and a professional military that can guard against foreign threats. In this article, I argue that leaders respond to domestic threats by promoting loyal officers and to foreign threats by promoting experienced officers. I draw on a new dataset, the first of its kind, of over 12,000 appointments to the People's Liberation Army of China. The data show that career ties and combat experience are critical for officer promotion to key military and party offices. However, in periods of high domestic threat, party leaders promote unusually large numbers of officers with personal ties to the top leader. In periods of foreign threat, on the other hand, leaders are more likely to promote officers with prior combat experience. The article challenges the conventional wisdom, showing how autocrats face a trade‐off between guarding against internal and external threats.
Impact of an improved driveline management for HeartMate II and HeartMate 3 left ventricular assist devices
Authors: Mutsuga Masato , Okumura Takahiro , Morimoto Ryota , Kondo Toru , Ito Hideki , Terazawa Sachie , Tokuda Yoshiyuki , Narita Yuji , Nishida Kazuki , Murohara Toyoaki , Usui Akihiko
Published: October 2022

Background

We evaluated the impact of a standardized driveline care strategy, including a subfascial‐tunneling method and dressing protocol, on the incidence of driveline infection (DLI).

Methods

DLI data from all HeartMate II (HMII) and HeartMate 3 (HM3) patients (including exchange devices) were retrospectively collected between 2013 and 2021. The driveline subfascial‐tunneling method was altered in three steps (A: right direct; B: left triple, C: right triple), and the shower protocol was changed in two steps (A: with/without cover, B: with cover). Disinfection was individually tailored after changing the shower protocol. Complications associated with morbidity and mortality were evaluated for each modification.

Results

During the study period, 80 devices were implanted (HMII, n = 54; HM3, n = 26). The 8‐year incidence of DLI was 15% (n = 8) in HMII patients and 0% in HM3 patients (p = 0.039). DLI was not associated with hospital mortality. The modified dressing protocol and tunneling method was associated with a significantly better DLI incidence rate in comparison to the previous one: Protocol‐A (n = 17), Protocol‐B (n = 63), 35% vs 3% (p = 0.0009), Method‐A (n = 13), Method‐B (n = 42), Method‐C (n = 25), 46% vs 5% vs 0% (p = 0.0001). The rete of freedom form DLI at 1, 2, and 3 years had also significant difference between groups: Protocol‐A and Protocol‐B, 80%, 54%, 54% vs 96%, 96%, 96%, respectively (p < 0.0001), Method‐A, Method‐B and Method‐C, 76%, 44%, 44%, vs 94%, 94%, 94% vs 100%, 100%, respectively (p < 0.0001).

Conclusions

A standardized triple driveline tunneling strategy and waterproof dressing protocol reduced driveline infection in HM3 patients to 0%.
Impact of advanced practice providers on characteristics and quality of care of patients with chronic hepatitis B
Authors: Kam Leslie Y. , Huang Daniel Q. , Tobias Alfred F. , Poon Kitty , Henry Linda , Kwo Paul , Cheung Ramsey , Nguyen Mindie H.
Published: October 2022

Background

Advanced practice providers (APP) may be able to play a role in improving the linkage to care in patients with chronic hepatitis B (CHB), but data are limited.

Aim

To compare management of patients with CHB under APP‐assisted versus physician‐only care

Methods

This retrospective analysis identified patients with CHB infection from Optum's de‐identified Clinformatics® Data Mart Database (2003–2021) using ICD‐9/ICD‐10 codes. We compared the proportion of patients with CHB who had adequate evaluation for treatment (defined as ALT, HBV DNA, ± HBeAg), and the proportion of treatment‐eligible patients with CHB who received treatment between APP versus physician‐only care.

Results

We included 42,140 eligible patients (mean age: 51.9 ± 15.1; 56.1% male). Overall, 34.3% received APP care with increasing utilisation over time. Compared to physician‐only care, patients who also received APP care were more likely to have viral co‐infection, and more likely to have been seen by a specialist (72.1%). Overall, 62.8% and 56.2% of treatment‐eligible patients based on AASLD and EASL guidelines, respectively, received treatment. APP care patients were more likely to be treated (AASLD adjusted HR: 1.18, 95%CI: 1.03–1.34; EASL adjusted HR:1.24, 95%CI: 1.09–1.41) after adjustment for age, sex, race/ethnicity, viral dual infection, baseline cirrhosis/liver cancer, number of HBV DNA and alanine aminotransferase measurements, and physician provider type.

Conclusion

Treatment‐eligible patients with CHB receiving APP care were more likely to receive antiviral therapy. APP care may help to expand the pool of providers for patients with CHB, and to improve current suboptimal treatment rates.
Distinguishing appropriate from inappropriate conditions on research participation
Authors: Steel Robert , Wendler David
Published: October 2022

Individuals do not have a right to participate in clinical trials. But, they do have a right against being denied participation for inappropriate reasons. Despite the widespread endorsement of these two claims, there has been little discussion regarding which conditions for participation in clinical trials are appropriate and which are inappropriate. The present manuscript attempts to address this gap in the literature. We first describe and then argue against the claim that conditions on enrollment or continued participation are appropriate only when they are needed to answer the scientific question(s) posed by the trial. We then offer an alternative view according to which the appropriateness of conditions depends on whether they help to satisfy the ethical requirements of clinical research. Because these requirements include social value, the present view implies that promoting social value is an acceptable reason to impose conditions on research participation. With this in mind, we explain why it is not coercive to require potential participants to accept conditions on enrollment that promote a trial's social value, even when the participants find those conditions unwelcome. We conclude by evaluating the present proposal's implications for the common practice of requiring participants to agree to the possible use of their leftover biospecimens in a broad range of future research. We argue, contra current regulatory policy, that this practice can be acceptable even when the present trial offers participants the prospect of clinical benefit and the samples are being reserved for future research that is unrelated to the present trial.
Therapeutic effects of Rosa canina, Urtica dioica and Tanacetum vulgare herbal combination in treatment of tinnitus symptoms: A double‐blind randomised clinical trial
Authors: Khosravi Mohammad Hossein , Atefi Amirhomayoun , Mehri Afsaneh , Sodeifian Fatemeh , Yousefi Jaleh , Bagheri Hagh Ali , Sohrabpour Saeed , Kazemi Fatemeh , Ajalloueian Mohammad , Saeedi Masoumeh
Published: October 2022

Objective

To evaluate the effect of Neurotec® herbal capsule (100 mg twice a day for 3 months) on the tinnitus symptoms in comparison with the placebo.

Design

A double‐blind randomised clinical trial.

Setting

Otolaryngology clinic of Baqiyatallah Hospital.

Participants

Patients suffering from subjective tinnitus.

Main Outcome Measures

Pure tone audiometry was measured at .5, 1, 2, 4 and 6 kHz frequencies before and after the third month of intervention. In addition, Tinnitus Handicap Inventory (THI) questionnaire as well as visual analogue scale (VAS) for tinnitus loudness, daily annoyance, daily life or sleep disturbance, daily perception and mood alteration were evaluated.

Results

Finally, 103 (69 males and 34 females) patients with a mean age of 51.33 ± 13.91 years were analysed. In contrast with control group, patients in intervention group showed a remarkable decrease in THI score after 3 months of treatment (p < .05). Although both groups had improvements in VAS scores, mood disturbance, daily tinnitus perception and daily life alteration scores were only improved in the intervention group. The mean pure tone air and bone conduction were not significantly different between the control and the intervention group at baseline and 3 months after the intervention at .5, 1, 2 and 4 kHz (p > .05).

Conclusion

A 3‐month treatment with Neurotec capsules in addition to patient education is of benefit for managing symptoms in patients with chronic tinnitus.
Risk factors for anastomotic leakage and postoperative outcomes after total and subtotal colectomy: A nationwide retrospective cohort study (RIALTCOT Study Collaborative Group)
Authors: Ocaña Juan , Pastor Paula , Timoteo Ander , Diez‐Alonso Manuel Mariano , de la Portilla Fernando , Cagigas Carmen , Labalde‐Martínez María , Espin Eloy , Dujovne Paula , Nieto Marta , González Manuel , Sanz Rodrigo , Pascual Marta , Aguirre‐Allende Ignacio , Cervera Jorge , Jiménez‐Carneros Virginia , Guadalajara Hector , García‐Granero Alvaro , Fernández‐Cebrián José María , Die‐Trill Javier ,   collaborators from the RIALTCOT Study Collaborative Work
Published: October 2022

Aim

Anastomotic leakage (AL) following ileorectal (IRA) or ileosigmoid (ISA) anastomosis is associated with a high morbidity. The identification of potential risk factors for AL could change operative planning and reduce further complications. This study assesses the rate, potential risk factors and management of AL after total colectomy (TC) and subtotal colectomy (STC).

Methods

A nationwide, multicentre, retrospective cohort study involved 26 Spanish referral centres. It included TC and STC with IRA or ISA patients between January 2013 and December 2020. Clinical data, primary surgery and complications were collected. Univariate and multivariate analysis to identify risk factors for AL were performed. Management of Grade B–C AL and permanent stoma rate was assessed according to revisional surgeries.

Results

The study included 1074 patients, 433 ISA group (40.3%) and 641 IRA group (59.7%). The overall incidence of AL was 14.3% with no differences between IRA and ISA (14.2% and 14.5% respectively), P = 0.871. Male sex, ASA score and lower total preoperative proteins were identified as independent risk factors for global and Grade B–C AL. Diverting ileostomy did not protect against AL (P = 0.084). Clavien–Dindo ≥IIIA complication was found in 251 patients (23.3%). Stoma reversal was not possible in 85 patients (8.1%), being more frequent after anastomosis excision and terminal ileostomy in AL Grade C.

Conclusion

Total colectomy and STC with IRA or ISA are high‐risk procedures with an increased AL rate. Male sex, ASA score and lower preoperative protein level were associated with global AL and AL Grade B and C. A lower permanent stoma rate could be obtained when diverting ileostomy is performed in revision surgery.
Role of cardiovascular magnetic resonance imaging in COVID‐19 recovered patients: A short‐term follow‐up study
Authors: Kunal Shekhar , Bagarhatta Prachi , Palleda Girish M. , Bansal Ankit , Batra Vishal , Daga Mradul K. , Tyagi Sanjay , Sharma Ashok , Bansal Kalpana , Agarwal Ritu , Gupta Mohit D.
Published: October 2022

Objective

Cardiac involvement in recovered COVID‐19 patients assessed by cardiac magnetic resonance imaging (MRI).

Methods

Subjects recently recovered from COVID‐19 and with an abnormal left ventricular global longitudinal strain were enrolled. Cardiac MRI in all the enrolled subjects was done at baseline (within 30–90 days following recovery from COVID‐19) with a follow‐up scan at 6 months in individuals with an abnormal baseline scan. Additionally, 20 age‐and sex‐matched individuals were enrolled as healthy controls (HCs).

Results

All the 30 enrolled subjects were symptomatic during active COVID‐19 disease and were categorized as mild: 11 (36.7%), moderate: 6 (20%), and severe: 13 (43.3%). Of the 30 patients, 16 (53.3%) had abnormal CMR findings. Myocardial edema was reported in 12 (40%) patients while 10 (33.3%) had late gadolinium enhancement (LGE). No difference was observed in terms of conventional left ventricular (LV) parameters; however, COVID‐19‐recovered patients had significantly lower right ventricular (RV) ejection fraction, RV stroke volume, and RV cardiac index compared to HCs. Follow‐up scan was abnormal in 4/16 (25%) with LGE persisting in three patients (who had severe COVID‐19 [3/4;75%]). Subjects with severe COVID‐19 had a greater frequency of LGE (53.8%) and myocardial edema (61.5%) as compared to mild and moderate cases. Myocardial T1 (1284 ± 43.8 ms vs. 1147.6 ± 68.4 ms; p < .0001) and T2 values (50.8 ± 16.7 ms vs. 42.6 ± 3.6 ms; p = .04) were significantly higher in post COVID‐19 subjects compared to HCs. Similarly, T1 and T2 values of severe COVID‐19 patients were significantly higher compared to mild and moderate cases.

Conclusions

An abnormal CMR was seen in half of the recovered patients with persistent abnormality in one‐fourth at 6 months. Our study suggests a need for closer follow‐up among recovered subjects in order to evaluate for long‐term cardiovascular sequelae. COVID‐19 causes structural changes in the myocardium in a small segment of patients with partial spontaneous resolution.