bluuebunny/crossref_metadata_2025 huggingface dataset:
No Evidence for Social Selection and Peer Influence on Grades and Literacy Among Early Adolescents Through Friendship Ties
Authors: Lintner Tomáš
Published: August 2024

Friends in early adolescence play a significant role in students’ lives, potentially influencing their academic performance. A multi-group stochastic actor-oriented model was employed to examine the effects of social selection and peer influence through friendship ties on Czech language grades and reading literacy among lower-secondary students, controlling for students' SES, gender, and network structure. The sample comprised 276 sixth-grade students across twelve classrooms, measured at two time points with an interval of seven months. No evidence of selection or influence in terms of grades and literacy was found. However, effects of gender and SES assortativity were observed. The findings are discussed in relation to potential publication bias in the existing literature, and implications for future research are outlined.
Numerical investigation into effects of slot control on flow around wind turbine blades
Authors: Dilmaghani Sasan Malekzadeh , Abedini Saeid , Adelifar Ayda , Mogani Reza
Published: August 2024

This paper investigates the effects of slots on wind turbine blade sections on the reduction of fluid loads on the airfoil in turbulent flows. The governing conversation equations were discretized using the finite volume method (FVM), numerically simulating an unsteady flow with a turbulent regime. It was found that slots at ΨA70° and high angles of attack (AOAs) improved the aerodynamic performance of the airfoil and delayed the stall by 2°. The Cl-Cd ratio was 31.49%, 79.22%, and 29.66% higher in the slotted airfoil than in the non-slotted one at an AOA of 18°, 20°, and 22°, respectively. Furthermore, slots with ΨA70° at AOAs of 20° and 22° substantially reduced lift and drag variations on the airfoil.
Disturbance observer-based finite-time adaptive neural control scheme of DFIG-wind turbine
Authors: Bounar Naamane , Boulkroune Abdesselem , Labdai Sami , Chrifi-Alaoui Larbi , Khebbache Hicham
Published: August 2024

This paper introduces a novel disturbance observer-based finite-time adaptive neural control approach to optimize wind power conversion in a doubly fed induction generator-based wind turbines (DFIG-WT). This control strategy offers appealing features including rapid finite-time convergence, both transient and steady-state performance enhancements, and robustness against external disturbances and inherent model uncertainties. The control strategy integrates the neural networks estimation capability with the interesting proprieties of the finite-time control method to achieve efficient wind power conversion. Closed-loop finite-time stability is conducted using the finite-time Lyapunov stability concept of nonlinear systems. The developed control strategy’s effectiveness is confirmed through numerical simulation.
Patient and Operative Risk Factors for Osteoarthritis After Primary Anterior Cruciate Ligament Reconstruction: A Cohort Study of 41,976 Patients
Authors: Prentice Heather A. , Chan Priscilla H. , Paxton Elizabeth W. , Felson David T. , Funahashi Tadashi T. , Maletis Gregory B.
Published: August 2024

Background:

The reported incidence of posttraumatic knee osteoarthritis (PTOA) after primary anterior cruciate ligament reconstruction (ACLR) varies considerably. Further, there are gaps in identifying which patients are at risk for PTOA after ACLR and whether there are modifiable factors.

Purpose:

To (1) determine the incidence of PTOA in a primary ACLR cohort and (2) identify patient and perioperative factors associated with the development of PTOA after primary ACLR.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Data from the Kaiser Permanente ACLR Registry were used to conduct a cohort study. Patients who had undergone primary ACLR without a previous diagnosis of osteoarthritis were identified (2009-2020). The crude incidence of PTOA was calculated using the Aalen-Johansen estimator with a multistate model. The association of patient and operative factors with the development of PTOA after primary ACLR was modeled as a time to event using multistate Cox proportional hazards regression. Models stratified by age (<22 and ≥22 years) were also conducted because of the effect modification of age.

Results:

The study sample included 41,976 cases of primary ACLR. The incidence of PTOA was 1.7%, 5.1%, and 13.6% at 2, 5, and 10 year follow-ups, respectively. Risk factors for PTOA that were consistently identified in the overall cohort and age-stratified groups included a body mass index ≥30 versus <30 and an allograft or quadriceps tendon autograft versus a hamstring tendon autograft. Patients presenting with knee pain after ACLR were further identified when considering postoperative factors. Other risk factors for PTOA in the overall cohort included age ≥22 versus <22 years, bone–patellar tendon–bone autograft versus hamstring tendon autograft, hypertension, cartilage injury, meniscal injury, revision after primary ACLR with concomitant meniscal/cartilage surgery, multiligament injury, other activity at the time of injury compared with sport, and tibial tunnel drilling technique rather than the anteromedial portal.

Conclusion:

Knee pain after ACLR may be an early sign of PTOA. Surgeons should consider the adverse associations of a higher body mass index and an allograft or quadriceps tendon autograft with the development of PTOA, as these were factors identified with a higher risk, regardless of a patient’s age at the time of primary ACLR.
Sex-Specific Outcomes After Anterior Cruciate Ligament Reconstruction Using an All–Soft Tissue Quadriceps Tendon Autograft in a Young Active Population
Authors: Petit Camryn B. , Slone Harris S. , Diekfuss Jed A. , Barber Foss Kim D. , Warren Shayla M. , Montalvo Alicia M. , Lamplot Joseph D. , Myer Gregory D. , Xerogeanes John W.
Published: August 2024

Background:

The ideal graft for anterior cruciate ligament (ACL) reconstruction (ACLR) in young athletes has a high return-to-sport (RTS) rate and a low reinjury rate. Quadriceps tendon autografts are being used with increasing frequency for ACLR in this population, despite a paucity of evidence to support their use.

Purpose:

To report the RTS rate, ipsilateral reinjury rate, and contralateral ACL injury rate in a young athletic population undergoing primary ACLR using an all–soft tissue quadriceps tendon (ASTQT) autograft.

Study Design:

Cases series; Level of evidence, 4.

Methods:

Patients aged 14 to 22 years who underwent primary ACLR using an ASTQT autograft by a single surgeon between January 1, 2005, and April 30, 2020, were identified via electronic medical records and contacted ≥24 months after ACLR to complete a survey regarding subsequent ipsilateral or contralateral ACL injuries and RTS. Patients who had undergone previous ACLR (ipsilateral or contralateral) were excluded.

Results:

A total of 656 patients (330 male, 326 female; mean age, 17.9 years) were identified, and 395 patients completed the survey (60.2%; 174 male, 221 female; mean age, 17.8 years) with a mean follow-up of 73 ± 29 months (range, 24-139 months). The RTS rate was high (male: 87.7%; female: 82.8%; P = .19). Male and female patients had similar rates of revision ACLR (male: 12.6%; female: 10.0%; P = .40) and contralateral ACL injuries (male: 13.8%; female: 11.3%; P = .46).

Conclusion:

A high RTS rate and similar rates of ipsilateral and contralateral ACL injuries were found for male and female patients in a young athletic population undergoing primary ACLR using an ASTQT autograft. These results help one to better understand the utility of ASTQT grafts to support successful ACLR in young athletic populations, for which ASTQT grafts appear to yield favorable outcomes.
The Association of Preoperative Hip Pain Duration With Delayed Achievement of Clinically Significant Outcomes After Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome
Authors: Vogel Michael J. , Jan Kyleen , Kazi Omair , Wright-Chisem Joshua , Nho Shane J.
Published: August 2024

Background:

Patients with hip pain ≥2 years before hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) have been shown to achieve inferior short-term and midterm outcomes compared with patients with a shorter pain duration, although there is limited literature that has evaluated the time to achieve clinically significant outcomes (CSOs) in this population.

Purpose:

To compare the time to achieve CSOs after hip arthroscopic surgery for FAIS in patients with and without prolonged hip pain and to identify independent predictors of the delayed achievement of CSOs.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients who underwent primary hip arthroscopic surgery for FAIS between January 2012 and July 2019 with 6-month, 1-year, and 2-year Hip Outcome Score–Activities of Daily Living (HOS-ADL) and Hip Outcome Score–Sports Subscale (HOS-SS) scores were identified. Patients with prolonged hip pain (preoperative duration ≥2 years) were propensity score matched to a control group (preoperative duration <2 years), controlling for age, sex, and body mass index (BMI). The times to achieve the minimal clinically important difference and Patient Acceptable Symptom State were compared between groups using Kaplan-Meier survival analysis. Multivariate Cox regression considering age, sex, BMI, pain duration, activity level, and chondral status was used to identify independent predictors of the delayed achievement of CSOs.

Results:

A total of 179 patients with prolonged hip pain were matched to 179 control patients (mean pain duration, 60.5 ± 51.2 vs 9.7 ± 5.1 months, respectively; P < .001) of a similar age, sex, and BMI ( P≥ .488) with similar baseline HOS-ADL and HOS-SS scores ( P≥ .971). The prolonged hip pain group showed delayed achievement of the minimal clinically important difference and Patient Acceptable Symptom State for both the HOS-ADL and HOS-SS on Kaplan-Meier analysis ( P≤ .020). On multivariate Cox regression, hip pain duration ≥2 years was shown to be an independent predictor of the delayed achievement of CSOs, with hazard ratios ranging from 1.32 to 1.65 ( P≤ .029). Additional independent predictors of the delayed achievement of CSOs included increasing age, increasing BMI, female sex, self-endorsed weekly participation in physical activity, and high-grade chondral defects (hazard ratio range, 1.01-4.89; P≤ .045).

Conclusion:

Findings from this study demonstrate that preoperative hip pain duration ≥2 years was an independent predictor of the delayed achievement of CSOs after primary hip arthroscopic surgery for FAIS.
Career Length After Surgically Treated ACL Plus Collateral Ligament Injury in Elite Athletes
Authors: Pinheiro Vitor Hugo , Laughlin Mitzi , Borque Kyle A. , Ngo Dylan , Kent Madison R. , Jones Mary , Neves Nuno , Fonseca Fernando , Williams Andy
Published: August 2024

Background:

Limited data are available regarding career length and competition level after combined anterior cruciate ligament (ACL) and medial- or lateral-sided surgeries in elite athletes.

Purpose:

To evaluate career length after surgical treatment of combined ACL plus medial collateral ligament (MCL) and ACL plus posterolateral corner (PLC) injuries in elite athletes and, in a subgroup analysis of male professional soccer players, to compare career length and competition level after combined ACL+MCL or ACL+PLC surgeries with a cohort who underwent isolated ACL reconstruction (ACLR).

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A consecutive cohort of elite athletes undergoing combined ACL+MCL and ACL+PLC surgery was analyzed between February 2001 and October 2019. A subgroup of male elite soccer players from this population was compared with a previously identified cohort having had isolated primary ACLR without other ligament surgery. A minimum 2-year follow-up was required. Outcome measures were career length and competition level.

Results:

A total of 98 elite athletes met the inclusion criteria, comprising 50 ACL+PLC and 48 ACL+MCL surgeries. The mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Return-to-play (RTP) time was significantly longer for ACL+PLC injuries (12.8 months; P = .019) than for ACL+MCL injuries (10.9 months). In the subgroup analysis of soccer players, a significantly lower number of players with combined ACL+PLC surgery were able to RTP (88%; P = .003) compared with 100% for ACL+MCL surgery and 97% for isolated ACLR, as well as requiring an almost 3 months longer RTP timeline (12.9 months; P = .002) when compared with the isolated ACL (10.2 months) and combined ACL+MCL (10.0 months) groups. However, career length and competition level were not significantly different between groups.

Conclusion:

Among elite athletes, the mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Professional soccer players with combined ACL+PLC surgery returned at a lower rate and required a longer RTP time when compared with the players with isolated ACL or combined ACL+MCL injuries. However, those who did RTP had the same career longevity and competition level.
Midterm Outcomes After Simultaneous Hip Arthroscopic Surgery for Bilateral Femoroacetabular Impingement
Authors: Marty Eric , Keeter Carson , Henry Kaleigh , Kraeutler Matthew J. , Lee Jessica H. , Mei-Dan Omer
Published: August 2024

Background:

Bilateral hip arthroscopic surgery for the treatment of femoroacetabular impingement (FAI) has demonstrated good outcomes at short-term follow-up, with significant improvements in pain, hip function, and patient-reported outcomes, coupled with a complication rate similar to that of unilateral surgery.

Purpose:

To investigate whether, in patients with bilateral symptomatic FAI, simultaneous bilateral hip arthroscopic surgery is an efficacious option that produces effective midterm outcomes.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A prospective database of patients who underwent primary hip arthroscopic surgery between August 2012 and October 2020 was used to collect clinical data on 2 groups. Group 1 consisted of patients who underwent simultaneous bilateral hip arthroscopic surgery for the treatment of FAI. Group 2 represented a matched-pair control group of patients selected based on sex and age with signs and symptoms of unilateral FAI and in whom a single side was evaluated and treated. Differences in the International Hip Outcome Tool–12 and Non-Arthritic Hip Score scores were evaluated up to 5 years postoperatively.

Results:

In total, 171 patients (235 hips) were included, of whom 64 underwent simultaneous bilateral hip arthroscopic surgery (128 hips) and a control group of 107 patients (107 hips) underwent unilateral hip arthroscopic surgery. No significant differences were observed in International Hip Outcome Tool–12 scores between the 2 groups at 6 weeks, 3 months, 1 year, 2 years, and 5 years postoperatively. No significant differences were observed in Non–Arthritic Hip Score scores between the simultaneous bilateral and control groups at 6 weeks, 3 months, 6 months, 1 year, 2 years, and 5 years postoperatively. Overall, 18% of hips in the simultaneous bilateral group reported lateral femoral cutaneous nerve palsy at 2-week follow-up in comparison to 16% of hips in the control group.

Conclusion:

Simultaneous bilateral hip arthroscopic surgery for the treatment of FAI represents a safe treatment option, producing effective midterm outcomes in appropriately selected patients.
Dense and Disconnected: Analyzing the Sedimented Style of ChatGPT-Generated Text at Scale
Authors: Markey Ben , Brown David West , Laudenbach Michael , Kohler Alan
Published: August 2024

ChatGPT and other LLMs are at the forefront of pedagogical considerations in classrooms across the academy. Many studies have spoken to the technology’s capacity to generate one-off texts in a variety of genres. This study complements those by inquiring into its capacity to generate compelling texts at scale. In this study, we quantitatively and qualitatively analyze a small corpus of generated texts in two genres and gauge it against novice and published academic writers along known dimensions of linguistic variation. Theoretically, we position and historicize ChatGPT as a writing technology and consider the ways in which generated text may not be congruent with established trajectories of writing development in higher education. Our study found that generated texts are more informationally dense than authored texts and often read as dialogically closed, “empty,” and “fluffy.” We close with a discussion of potentially explanatory linguistic features, as well as relevant pedagogical implications.
Variability in Antimicrobial Prescribing Across Five Ambulatory Settings Within a Large Integrated Health System
Authors: Taylor Alex D. , Rivard Kaitlyn R. , Pallotta Andrea M. , Daniels Heather L. , Fraser Thomas G. , Fertel Baruch S. , Lam Simon , Wu Janet Y.
Published: August 2024

Background: Lack of access to timely, detailed antibiotic use data has limited ambulatory antibiotic stewardship efforts. Antibiotic utilization is tracked across ambulatory care sites and emergency departments (ED) within a large integrated health system. Methods: This is a retrospective cohort analysis from June 1, 2019 to May 31, 2020 comparing antibiotic prescribing for all patients with ICD-10 diagnosis codes for cystitis, otitis media, pharyngitis, sinusitis, and upper respiratory tract infections (URTIs) among five ambulatory care departments across northeast Ohio and southeast Florida locations: ED, Urgent Care (UC), On-Demand Telehealth (TEL), Pediatrics (PED), and Primary Care (PC). Results: A total of 261,947 encounters were included (ED:56,766, UC:92,749, TEL:8,783, PED:29,151, PC:74,498) for the treatment of cystitis (30,932), otitis media (22,094), pharyngitis (59,964), sinusitis (53,693), or URTI (95,264). The population was 63% female with a median age of 34.2 years [12.8-56.3]. A total of 17% of patients had documented penicillin allergies and 18% of patients with pharyngitis received Group A Streptococcus (GAS) testing. Antibiotics were prescribed in 44% of encounters (ED:21,746 [38%], UC:45,652 [49%], TEL:4,622 [53%], PED:10,909 [37%], PC:33,547 [45%]; P < 0.001). Guideline concordant antibiotics were prescribed in 65% of encounters (ED:14,338 [66%], UC:31,532 [69%], TEL:3,869 [84%], PED:8,212 [75%], PC:17,263 [51%]; P < 0.001). Conclusions: Observed rates of antibiotic and guideline concordant antibiotic prescribing were similar to national published rates of antibiotic prescribing in the ambulatory setting. The variability in antibiotic prescribing demonstrates opportunities for targeted outpatient stewardship efforts. Timely antibiotic tracking tools can facilitate ambulatory antimicrobial stewardship activities.
International higher education as knowledge diplomacy: The role of Chinese universities in China’s belt and road initiative
Authors: Liu Wei , Yan Tingxing , Li Yan , Lv Weidong
Published: August 2024

As an important player in China’s international relations, Chinese universities have been actively involved in China’s international development projects along China’s “Belt and Road Initiative (BRI)” routes. In this study, three Chinese universities are invited to share their collaborative education projects with three developing regions of the world: Central Asia, South East Asia and Africa. Using knowledge diplomacy as a theoretical lens to examine the three cases, this study aims to describe and evaluate the role of Chinese universities in the BRI programs in meeting the urgent talent needs of key infrastructure and energy industries in the global south. Through these three cases, the study also aims to shed light on China’s economic goals in international education that are currently absent in policy documents and academic literature.
The effect of an auxiliary spring on the decrease of contact resistance and contact temperature for power automotive connector
Authors: Beloufa Amine
Published: August 2024

Power automotive connectors used to connect two electrical systems in an electric vehicle should resist the rising of electric power or electric current. The latter can cause a rise in contact temperature by the Joule effect and can damage a connector improperly designed. The purpose of this work is to study experimentally and numerically the influence of the addition of a second spring on the ability of a power connector to transmit a high current. For this reason, an experimental test has been held on a connector without a second spring to measure contact resistance and contact temperature; then, a finite element model FEM of this connector was developed to compare and validate the numerical results with the experimental results. In addition, another FE model with a second spring was used to minimize contact resistance and contact temperature. Moreover, a theoretical model has shown its effectiveness in contact temperature and contact area calculations; it provides good agreement with experimental and numerical results. Numerical results show that the effect of the addition of a 2nd spring on the decrease of the contact temperature and contact resistance is significant. In addition, the thermo-electrical analysis by finite element shows that the current limit supported by a power connector with an auxiliary spring will equal twice the current supported by a power connector with one spring. FE mechanical analysis shows that the maximum mechanical stress in the connector with an auxiliary spring remains lower than the 2nd spring material yield stress. Finally, experimental and numerical results are in good agreement.
Analysis of Geometric and Material Parameters in the Modal Stability of Wind Turbine Brakes Using the Complex Eigenvalue Method
Authors: Nascimento Rodrigues Romulo do , Achtenová Gabriela , Kazda Lukáš , Klír Vojtěch , Vieira Gonçalves Vanessa , Araujo Bezerra Roberto de , Cardoso Macie Mateus Holanda
Published: August 2024

Wind energy is a sustainable and forward-thinking investment, harnessing the vast power of the wind to generate electricity. Recent decades have seen significant advancements in floating offshore wind turbines (FOWTs), which hold great potential for expanding offshore wind energy infrastructure. While wind power has grown in popularity, it has raised questions about the operations and maintenance of wind turbines, particularly those located in remote and challenging environments. Offshore wind energy offers optimal wind conditions and construction flexibility, but FOWTs face complex marine conditions, including turbulent forces, wind variations, and unpredictable weather events. Emergency Mechanical Braking (EMB) is commonly used to swiftly stop wind turbines during adverse conditions, but frequent use can lead to structural oscillations, mooring failures, and blade damage. These issues can result in emergency situations, increased downtime, and higher maintenance costs. One significant challenge in understanding wind turbine brake system instability is the cost of experimental studies. To address this, our work introduces an iterative method that establishes correlations between brake component properties (like Young’s modulus and friction coefficient), geometric and operational parameters, and key instability factors such as frequency and intensity. Using finite element analysis and complex eigenvalue analysis, this approach focuses on reducing vibration instability and optimizing braking performance. Our study yielded intriguing results, including the observation that reducing brake pad thickness, whether through design choices or natural wear, decreases total unstable points but shifts instabilities to lower frequencies. Ultimately, our research highlights the importance of various parameters in wind turbine brake system instability.
Cumulative Analysis of Device-associated Hospital-acquired Infection Quality Indicators in a Teaching Hospital in Telangana
Authors: Karuppiah Yazhini
Published: August 2024

Background and Aims:

In the realm of healthcare, device-associated hospital-acquired infections (DA-HAIs) pose significant challenges. These infections occur due to invasive medical devices and can lead to serious complications for patients. This study intends to assess the trends in device-associated infections over time in order to improve patient safety and quality through measurements and improvements in device-associated infections.

Methods:

The Department of Microbiology conducted a routine surveillance using a specific infection surveillance proforma for various healthcare-associated infections, including ventilator-associated events (VAEs), central line–associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). The data were examined at the end of each month, and the infection rate was determined using CDC guidelines.

Results:

The overall rate of HAI was found to be 1.69 HAI cases per 1,000 patient days. The cumulative DAI rates for the years 2021 and 2022 were CAUTI 6.14/1,000 urinary catheter days, CLABSI 4.5/1,000 central line catheter days and VAE 16.3/1,000 ventilator days.

Discussion:

It was observed that the CAUTI and CLABSI rates in our institution were comparable to or slightly higher than the national standard benchmark and INICC report and were significantly higher compared to the CDC/NHSN benchmark. The VAE rate was comparable to INICC report but was significantly higher compared to the NSB and the CDC/NHSN reports.

Conclusion:

Individual hospitals should make efforts to generate and evaluate their DAI trends and overall HAI rates and implement and improve their infection control programme to collectively achieve the target in our country in bringing down HAIs.
Risky Decisions Over Troubled Waters: Public Works Directors’ Sea Level Rise Risk Attitudes
Authors: Hines Robert E.
Published: August 2024

Local governments will be forced to navigate uncertain sea level rise projections as they fight to protect their key infrastructure systems from rising seas. As leaders in their departments, public works directors must make key project prioritization decisions as seas rise. So, how do they navigate the risk and uncertainty of sea level rise? This study tests if public works directors’ prioritization decisions align with the predictions of cumulative prospect theory, by inviting public works directors working in local governments on the United States coast to participate in a decision-making experiment. Results indicate that public works directors’ risk preferences differ from cumulative prospect theory because directors tend to be decreasingly sensitive to increases in assets’ criticality and probability of failure. As a result, public works directors are characterized as risk averse when prioritizing projects.
Bending performance and failure mechanisms of composite sandwich structures with 3D printed hybrid triply periodic minimal surface cores
Authors: Liu Peihong , Qi Wen , Luo Ketong , Yin Cailiu , Li Jiayao , Lu Chun , Lu Lina
Published: August 2024

In this paper, a novel hybrid triply periodic minimal surface (TPMS) core with a nonlinear transition region was designed by combining two types of TPMS (Diamond and Schwarz P) structures using the sigmoid function. The width of the transition region was precisely regulated by adjusting the gradient control parameter r in the sigmoid function. Composite sandwich structures (CSS) were fabricated by bonding two carbon fiber reinforced polymer (CFRP) face sheets to a 3D printed polylactic acid (PLA) core. The bending performance and failure mechanisms of the CSSs with the hybrid TPMS cores were analyzed through three-point bending tests and finite element analysis (FEA). The results indicate that as r increases, the transition region of the hybrid TPMS cores becomes narrower, leading to a gradual decrease in bending strength, bending stiffness, and core shear stress. The failure process of the CSSs in the experiment aligns well with the FEA results. Through comparative analysis of the stiffness-to-weight and strength-to-weight ratios of the CSSs with the native TPMS cores, the hybrid TPMS cores with a wider transition region enhance the structural efficiency of the CSSs, while those with a narrower transition region negatively impact the performance of the CSSs.
Incidence and risk factors of complications during central venous access devices removal in children
Authors: Liu Sue , Nataraja Ramesh M , Lynch Amiria , Ferguson Peter , Pacilli Maurizio
Published: August 2024

Purpose:

To quantify the rates and identify risk factors for the complications of central venous access devices (CVADs) removal in children.

Method:

Retrospective (2018–2023) review of children undergoing CVADs removal at a single institution. Data are reported as frequency, percentages and median. Logistic regression analysis was used to identify risk factors associated with difficult removal. Receiver Operating Characteristic Curve (ROC) analysis was conducted to identify the age cut-off and positive likelihood ratio (+LH) for the indwelling time associated with complicated removal. p-Value <0.05 were considered statistically significant.

Results:

We identified 208 CVAD removals with a median age of 7.2 (0.2–18.4) years including 116 (55.8%) males. The median CVAD placement duration was 1.26 years (0.4–5.7) years. Indications for insertion included acute lymphoblastic leukaemia (ALL; 78/208, 37.5%), lymphomas (31/208, 14.9%), other malignancies (58/208, 27.9%). Removal indications included completion of treatment (144/208, 69.2%), infection (22/208, 10.6%), malfunction (7/208, 3.4%) and other reasons (35/208, 16.8%). There were 20 (9.6%) complications characterised by difficulty removing the CVAD. Complicated removals were more likely to occur in children with ALL as the primary diagnosis ( p = 0.001); independently of the indication for insertion, longer indwelling time was associated with higher risk of complicated removal ( p < 0.001). Indwelling time >2.09 years was associated with a 2.87 increased risk of difficult removal.

Conclusion:

In our experience, almost 10% of CVAD removals in children result in complications. These findings are associated with an indwelling time >2 years; strategies to prevent complicated removals should be considered in children requiring long-term central venous access.
Choice of needleless connector technology as a risk reduction strategy for catheter related bloodstream infection, mortality, and cost: A secondary data analysis
Authors: Ryder Marcia , Battle Jason
Published: August 2024

Objective:

To compare relative risk (RR) of central line-associated bloodstream infection (CLABSI) between hospitals using Clave needleless connector technologies (NCT) and comparator hospitals using non-Clave NCT. And, to estimate avoided CLABSIs, mortality, and cost savings.

Background:

Needleless connectors, while protective against needlestick injury, have long been implicated as a potential risk for CLABSI. Significant RR reduction of CLABSI among the many NCT has not been clinically demonstrated.

Methods:

The U.S. Healthcare-Associated Infections database was accessed for CLABSI data for calendar year 2019 via the Centers for Medicare and Medicaid Services website. This dataset was merged with the Clave NCT manufacturer’s 2019 database to identify hospitals purchasing Clave NCT (MicroClave™, NanoClave™, Clave Neutron™, Clave™, Microclave™ Clear) and non-Clave NCT comparator hospitals. Sub-analysis of Clave NCT hospitals included: (1) Clave NCT mixed-use and (2) Clave high-volume use hospitals. The standardized infection ratio (SIR) was generated to estimate CLABSI RR after adjusting for intern/resident-to-bed-ratio (IRB), care location, and hospital demographics. Using the RR, avoided CLABSIs, mortality, and cost savings were calculated.

Results:

A total of 2987 eligible hospitals (1288 Clave NCT, 1699 non-Clave NCT) with 17,452,575 central line-days were evaluated. All three Clave NCT hospital groups showed a statistically significant reduction in RR compared to the non-Clave NCT hospitals. The RR in Clave NCT hospitals was 0.93, a 7% decrease in CLABSI risk ( p = 0.02). In the Clave NCT subgroups, mixed-use hospitals RR was 0.93, a 7% reduction ( p = 0.04), while the Clave NCT high-volume hospitals experienced a 19% reduction, RR 0.81 ( p = 0.04). An estimated 563 CLABSIs and 84 related deaths were avoided with use of Clave NCT and $27,095,231 in cost savings.

Conclusion:

The use of the Clave NCT, in and of itself, is an effective risk reduction strategy for CLABSI prevention, reduced mortality, and substantial cost savings.
An abysmal conundrum associated with a misplaced dialysis catheter
Authors: Muralidharan Shruthi , Asokan Arunkumar , Raja Rajan Nembian , Mathew Gerry George , Jayaprakash Varadharajan
Published: August 2024

A 25-year-old female patient with chronic glomerulonephritis, initiated on haemodialysis presented with high-grade fever, a dysfunctional catheter, low oxygen saturation and unstable blood pressure. Upon evaluation, the patient was febrile with elevated white blood cell counts. She was intubated, started on inotropes and transferred to the intensive care unit. Chest radiography showed that the tunnelled internal jugular dialysis catheter had migrated to the inferior vena cava. Echocardiography and transoesophageal echocardiography showed severe heart dysfunction with a large thrombus attached to the catheter, indicating catheter-related atrial thrombus (CRAT). CT pulmonary angiography revealed blockage of the segmental pulmonary arteries, suggesting pulmonary embolism. Blood and tracheal cultures revealed Methicillin-resistant Staphylococcus aureus (MRSA). The patient was administered appropriate antibiotics and anticoagulants and underwent surgical removal of the thrombus and the catheter. This case demonstrates the risks associated with improper placement of dialysis catheters and highlights the brief management of CRAT.
A GAVeCeLT consensus on the indication, insertion, and management of central venous access devices in the critically ill
Authors: Pinelli Fulvio , Pittiruti Mauro , Annetta Maria Giuseppina , Barbani Francesco , Bertoglio Sergio , Biasucci Daniele G , Bolis Denise , Brescia Fabrizio , Capozzoli Giuseppe , D’Arrigo Sonia , Deganello Elisa , Elli Stefano , Fabiani Adam , Fabiani Fabio , Gidaro Antonio , Giustivi Davide , Iacobone Emanuele , La Greca Antonio , Longo Ferdinando , Lucchini Alberto , Marche Bruno , Romagnoli Stefano , Scoppettuolo Giancarlo , Selmi Valentina , Vailati Davide , Villa Gianluca , Pepe Gilda
Published: August 2024

Central venous access devices are essential for the management of critically ill patients, but they are potentially associated with many complications, which may occur during or after insertion. Many evidence-based documents—consensus and guidelines—suggest practical recommendations for reducing catheter-related complications, but they have some limitations. Some documents are not focused on critically ill patients; other documents address only some special strategies, such as the use of ultrasound; other documents are biased by obsolete concepts, inappropriate terminology, and lack of considerations for new technologies and new methods. Thus, the Italian Group of Venous Access Devices (GAVeCeLT) has decided to offer an updated compendium of the main strategies—old and new—that should be adopted for minimizing catheter-related complications in the adult critically ill patient. The project has been planned as a consensus, rather than a guideline, since many issues in this field are relatively recent, and few high-quality randomized clinical studies are currently available, particularly in the area of indications and choice of the device. Panelists were chosen between the Italian vascular access experts who had published papers on peer-reviewed journals about this topic in the last few years. The consensus process was carried out according to the RAND/University of California at Los Angeles (UCLA) Appropriateness Methodology, a modification of the Delphi method, that is, a structured process for collecting knowledge from groups of experts through a series of questionnaires. The final document has been structured as statements which answer to four major sets of questions regarding central venous access in the critically ill: (1) before insertion (seven questions), (2) during insertion (eight questions), (3) after insertion (three questions), and (4) at removal (three questions).
Successful creation and long-term usage of radiocephalic fistula based on the recanalized completely occluded radial artery
Authors: Xiong Yu , Chen Bo , Yuan Lijuan , Tu Bo , Wan Ziming
Published: August 2024

The total occlusion of radial artery is a contraindication for reintervention and further usage. In this study, we report successful revascularization with creation of radiocephalic fistula from post-procedural chronically-occluded radial artery. The completely occluded radial artery was recanalized through ultrasound guided balloon angioplasty. A traditional radiocephalic fistula was created subsequently by using the recanalized radial artery for hemodialysis therapy. Though the fistula was failed at the 6 weeks caused by the juxta anastomotic stenosis, the further ultrasound guided percutaneous transluminal angioplasty restored the blood, and the hemodialysis therapy lasts for more than 1 year so far. It’s feasible to create radiocephalic fistula based on the recanalized radial artery and maintain long-term hemodialysis therapy.
Management of cephalic arch stenosis in hemodialysis access: Updated systematic review and meta-analysis
Authors: Kim Hyangkyoung , Kim Young Shin , Labropoulos Nicos
Published: August 2024

Introduction:

Cephalic arch stenosis (CAS) is often recurrent, resistant to treatment and the intervention outcome is not well validated so far. We purposed to assess the clinical outcomes of CAS treatment in patients with hemodialysis access.

Methods:

Electronic bibliographic sources were searched up to December 4 2023 to identify studies reported outcome after treating CAS. Direct and indirect evidence was combined to compare odds ratios (OR) and surfaces under the cumulative ranking curves across the different treatment modalities through meta-analysis and network meta-analyses (NMA). This systematic review was conducted in accordance with the PRISMA-P. The review is registered in PROSPERO (CRD42022296513).

Results:

Four randomized controlled trials (RCTs) and 15 non-RCTs were included in the analysis. The study population differed in fistula type, restenosis or thrombosis, and significant heterogeneity was observed among the publications. The risk of bias was low to serious. Meta-analysis found no significant difference between DCB and PTA in primary patency at 6 and 12 months (OR 1.16 and 0.60, respectively; low certainty of evidence). Favorable result with STG compared to stent or PTA at 3, 6, and 12 month was observed (OR 4.28, 5.13, and 13.12, and 4.28, 5.13, 13.12, respectively; low certainty of evidence). Regarding primary patency, the treatment rankings, from highest to lowest, were STG (92.7%), transposition (76.0%), stent (67.5%), DCB (46.3%), and PTA (64.5%) at 12 months.

Conclusion:

Despite data limitations, the low-quality evidence suggests that STG may merit consideration as a primary treatment option when all alternatives are applicable, given their potential for better primary patency and higher treatment ranking.
Incidence of fatal and non-fatal pulmonary thromboembolism after removal of tunnelled central venous haemodialysis catheters without ultrasound scan and anticoagulation
Authors: Macpherson Ciara , Stoumpos Sokratis , Geddes Colin C
Published: August 2024

Background:

Catheter related thrombosis is a common complication of tunnelled central venous catheter (TCVC) usage. There are concerns that TCVC removal could dislodge a thrombus to cause pulmonary thromboembolism (PE). The incidence of PE following TCVC removal is unclear and so the aim of this study was to investigate the incidence of PE and whether it is high enough to warrant screening with ultrasound with a view to systemic anticoagulation prior to TCVC removal.

Methods:

1102 consecutive TCVC removals without ultrasound and systemic anticoagulation were included in this retrospective study. Data were extracted from electronic health records. Measures to identify PE events included: deaths, computed tomography pulmonary angiogram (CT-PA), isotope lung perfusion scans and D-dimers blood tests within 7 days of removal.

Results:

Of the 1102 TCVC removals, the mean age of patients was 56.9 years and 57.3% were male. The primary renal diagnosis for 24.5% of patients was diabetic nephropathy. There were seven deaths following removal, none of which had PE as a contributing cause on review of their clinical history and death certificates. Five CT-PAs and one isotope lung perfusion scan were carried out in the 7 days after TCVC removal and none had a positive finding of PE. Three patient had D-dimers measured in blood within 7 days and none of these patients were subsequently diagnosed with PE.

Conclusions:

There was no evidence of fatal or non-fatal PE’s occurring in the 7 days following TCVC removal. This would support the practice of removing TCVCs without the need for ultrasound screening and without a period of systemic anticoagulation.
Nephrology Partnership for Advancing Technology in Healthcare (N-PATH) Erasmus+ project: The Renal Expert in Vascular Access (REVAC) module
Authors: Lomonte Carlo , Ibeas Jose , Kitrou Panagiotis , Giusto Antonio , Baratto Marta , Bocchibianchi Valentina , Brunori Giuliano , Pirozzi Nicola , Ponikvar Rafael , Forneris Giacomo , Malik Jan , Katsanos Konstantinos , Snoeijs Maarten , Tozzi Matteo , Gallieni Maurizio , Gesualdo Loreto
Published: August 2024

The Renal Expert in Vascular Access (REVAC) is one of the four modules of the Nephrology Partnership for Advancing Technology in Healthcare (N-PATH) project, the first European-wide advanced training course in diagnostics and interventional nephrology, funded by Erasmus+ Knowledge Alliance, a European Commission program. The N-PATH primary goal was to train 40 young European nephrologists in both theoretical knowledge and practical skills related to interventional nephrology. The REVAC module focused on the crucial aspects of vascular access (VA) care in nephrology practice, as a complementary training path to the actual residency program. The aim was to provide nephrology fellows with comprehensive knowledge and skills related to VA management. The methodology was based on face-to-face meetings and online learning, modern facilities, experienced tutors, cutting edge simulators, augmented reality tools by means of a multidisciplinary international faculty and hands-on-courses. A feedback survey reported the experience of fellows who attended the REVAC module, confirming the positive impact on their ongoing nephrology training. We are confident that this project will revitalize their nephrology careers and will help training the next generation of nephrologists; they will be able to manage VA needs with the help of multi-disciplinary teams to safely optimize the care of hemodialysis patients.
Fecal Sludge Management and Sanitation Safety: An Assessment in Addis Ababa, Ethiopia
Authors: Sisay Shegaw Fentaye , Gari Sirak Robele , Ambelu Argaw
Published: August 2024

Background:

Sanitation safety practices and risks associated with fecal sludge management are crucial for public health and the environment. This study assessed sanitation safety practices and risks in Addis Ababa, Ethiopia, at different stages of fecal sludge management. The research aimed to understand the current state of sanitation facilities, practices, and associated risks and identify areas for improvement.

Materials and Methods:

A mixed methods/approach was employed, utilizing household surveys, risk assessments, and sanitary inspections. A total of 384 study subjects were interviewed using face-to-face interviews and observations.

Results:

The findings revealed that the majority of households (97.7%) had consistent access to toilets, with flush/pour flush toilets being the most common type (47.4%). Factors such as odors in toilets or septic tanks, open defecation by children, and the use of untreated wastewater for food production were significantly associated with sociodemographic factors. Risk assessments indicated that 67% of households fell into the low-risk category, while 33% were classified as intermediate risk. The study identified non-compliance issues during sanitary inspections at transfer stations (45%), a wastewater treatment and disposal facility (61.5%), and in the management of wastewater and sludge in the sewer line (64%). These findings call for urgent actions to address improper feces disposal, inadequate maintenance of sanitation facilities, and unsafe practices in fecal sludge management.

Conclusion:

This study identified concerning issues in fecal sludge management, including improper feces disposal, inadequate facility maintenance, and non-compliance with safety standards during emptying, transport, treatment, and disposal. Urgent action is needed to address these risks. Promoting proper disposal techniques, improving facility maintenance, education programs, strengthening regulations, providing training and protective equipment, and investing in enhanced sanitation facilities and wastewater treatment methods are essential for improving sanitation safety practices.
What Brazilianness looks like: SVODs’ impact on cultural representation
Authors: Meimaridis Melina , Mazur Daniela , Rios Daniel
Published: August 2024

This article investigates the complex interplay between subscription video on-demand services (SVODs) and the representation of Brazilianness in global media. Focusing on Brazil’s video streaming landscape, our study delves into the challenges of representing the diverse tapestry of national culture, particularly in content commissioned by foreign platforms. These challenges include technical barriers, such as the concentration of audiovisual production infrastructure in the Rio-São Paulo axis, and textual hurdles, like the perpetuation of stereotypes and exoticization of Brazilian narratives. Our investigation includes a review of historical limited portrayal of Brazilianness on domestic television, an analysis of SVOD content from 2016 to 2023, and a case study of two Brazilian original series: Cangaço Novo and How to be a Carioca. These series illuminate different aspects of Brazilian reality. Cangaço Novo depicts a less fictionalized ‘Brasil’ prevalent in mainstream media, featuring themes of drought, the sertão, and local resistance. In contrast, How to be a Carioca presents a more stereotyped ‘Brazil’ tailored for international audiences, focusing on preconceived notions about Rio de Janeiro. Our findings reveal a paradox in the role of SVODs: they perpetuate national stereotypes even as they provide global access to Brazilian content. These platforms shape and export perceptions of Brazil, influencing how the country is viewed both domestically and globally. We explore the tensions between local content creation and global distribution, emphasizing the complexities of globalization, diversity, and cultural identity within the markets of the Majority World.