bluuebunny/crossref_metadata_2025 huggingface dataset:
Labour and megaprojects: Rethinking productivity and industrial relations policy
Authors: Ellem Bradon
Published: January 2021

The coronavirus pandemic has brought industrial relations policy to the centre of attention in many countries. In 2020, the Australian government convened tripartite bodies to address policy in several areas, one being for agreement-making to cover labour on ‘megaprojects’. This initiative revisited criticisms of unions for driving costs up and productivity down on these worksites, the most expensive of which had been Chevron’s Gorgon site, a liquefied natural gas project off the north-west Australian coast. Drawing on four usually siloed literatures – on industrial relations policy, megaprojects, the economic geography of resources and labour process – this article explains concerns about costs, delays and productivity in terms of project work itself. This approach leads to a different understanding of the merits of changing policy to address megaproject’s problems and productivity more broadly.
Practical application of cost-utility analysis in summative evaluation
Authors: Trompf Mardi , Kotvojs Fiona
Published: January 2021

Donors prioritise evaluation of Value for Money (VfM) in development interventions; however, the theory and practice of doing so is still developing and applied inconsistently. Theory found in donor government guides and textbooks is often high-level and economic evaluation theory can be difficult to apply in practice. This is compounded when there are multiple stakeholder groups, patchy data quality and short time horizons for decision making. This article demonstrates how Cost-Utility Analysis (CUA) can be used as a programme evaluation tool to bring practice together with theory to meet donor needs, suit development environments and provide evaluation robustness in defensible VfM conclusions. The example described here is in the evaluation of a programme in Samoa, where almost AU$10 million was donated by the Governments of New Zealand and Australia for tourism industry assistance in recovery from the 2012 Tropical Cyclone Evan (TCE). The programme design had six delivery modalities and its subsequent evaluation included an analysis of the cost utility of each modality, feeding into a VfM conclusion. This practical application of CUA theory demonstrates an effective approach to evaluating VfM.
Samples sizes required to accurately quantify viral load and histologic lesion severity at the maternal–fetal interface of PRRSV-inoculated pregnant gilts
Authors: Malgarin Carolina M. , Zarate Javier B. , Novakovic Predrag , Detmer Susan E. , MacPhee Daniel J. , Harding John C. S.
Published: January 2021

Porcine reproductive and respiratory syndrome virus (PRRSV) is transmitted vertically, causing fetal death in late gestation. Spatiotemporal distribution of virus at the maternal–fetal interface (MFI) is variable, and accurate assessment of viral concentration and lesions is thus subject to sampling error. Our objectives were: 1) to assess whether viral load and lesion severity in a single sample of endometrium (END) and placenta (PLC), collected near the base of the umbilical cord (the current standard), are representative of the entire organ; and 2) to compare sampling strategies and evaluate if spatial variation in viral load can be overcome by pooling of like-tissues. Spatially distinct pieces of END and PLC of 24 fetuses from PRRSV-2–infected dams were collected. PRRSV RNA quantified by RT-qPCR was compared in 5 individual pieces per fetus and in respective pools of tissue and extracted RNA. Three distinct pieces of MFI were assessed for histologic severity. Concordance correlation and kappa inter-rater agreement were used to characterize agreement among individual samples and pools. The viral load of individual samples and pools of END had greater concordance to a referent standard than did samples of PLC. Larger pool sizes had greater concordance than smaller pool sizes. Average viral load and lesion severity did not differ by location sampled, and no technical advantages of pooling tissues versus RNA extracts were found. We conclude that multiple pieces of MFI tissues must be evaluated to accurately assess lesion severity and viral load. Three pieces per fetus provided a reasonable balance of cost and logistic feasibility.
Novel active magnetorheological knee prosthesis presents low energy consumption during ground walking
Authors: de Andrade Rafhael Milanezi , Martins Jordana Simões Ribeiro , Pinotti Marcos , Filho Antônio Bento , Vimieiro Claysson Bruno Santos
Published: January 2021

This study analyses the energy consumption of an active magnetorheological knee (AMRK) actuator that was designed for transfemoral prostheses. The system was developed as an operational motor unit (MU), which consists of an EC motor, a harmonic drive and a magnetorheological (MR) clutch, that operates in parallel with an MR brake. The dynamic models of the MR brake and MU were used to simulate the system’s energetic expenditure during over-ground walking under three different working conditions: using the complete AMRK; using just its motor-reducer, to operate as a common active knee prosthesis (CAKP), and using just the MR brake, to operate as a common semi-active knee prosthesis (CSAKP). The results are used to compare the MR devices power consumptions with that of the motor-reducer. As previously hypothesized, to use the MR brake in the swing phase is more energetically efficient than using the motor-reducer to drive the joint. Even if using the motor-reducer in regenerative braking mode during the stance phase, the differences in power consumption among the systems are remarkable. The AMRK expended 16.3 J during a gait cycle, which was 1.6 times less than the energy expenditure of the CAKP (26.6 J), whereas the CSAKP required just 6.0 J.
On size-dependent bending behaviors of shape memory alloy microbeams via nonlocal strain gradient theory
Authors: Zhou Bo , Kang Zetian , Ma Xiao , Xue Shifeng
Published: January 2021

This paper focuses on the size-dependent behaviors of functionally graded shape memory alloy (FG-SMA) microbeams based on the Bernoulli-Euler beam theory. It is taken into consideration that material properties, such as austenitic elastic modulus, martensitic elastic modulus and critical transformation stresses vary continuously along the longitudinal direction. According to the simplified linear shape memory alloy (SMA) constitutive equations and nonlocal strain gradient theory, the mechanical model was established via the principle of virtual work. Employing the Galerkin method, the governing differential equations were numerically solved. The functionally graded effect, nonlocal effect and size effect of the mechanical behaviors of the FG-SMA microbeam were numerically simulated and discussed. Results indicate that the mechanical behaviors of FG-SMA microbeams are distinctly size-dependent only when the ratio of material length scale parameter to the microbeam height is small enough. Both the increments of material nonlocal parameter and ratio of material length-scale parameter to the microbeam height all make the FG-SMA microbeam become softer. However, the stiffness increases with the increment of FG parameter. The FG parameter plays an important role in controlling the transverse deformation of the FG-SMA microbeam. This work can provide a theoretical basis for the design and application of FG-SMA microstructures.
Modelling and experimental evaluation of a variable stiffness MR suspension with self-powering capability
Authors: Zhu Xiaojing , Ning Donghong , Hao Zhuonan , Huang Hui , Sun Yan Zhi , Jia Hong , Sun Shuaishuai , Yan Tianhong , Li Weihua
Published: January 2021

This paper presents the modelling and experimental evaluation of a semi-active vehicle suspension installed with a self-powered MR damper which is able to perform variable stiffness. Its variable stiffness feature as well as the self-powering capability was evaluated and verified using a hydraulic Instron test system. The testing results show that the stiffness of the damper is dependent on the current which can be generated by the self-powering component. A mathematic model was established to describe the dynamic properties of the MR damper and its power-generating capability. Finally, the self-powered MR suspension was installed on a quarter car test rig for its vibration isolation evaluation. A controller based on the short-time Fourier transform (STFT) was developed for the stiffness control. The evaluation result illustrates that the proposed MR damper can reduce the acceleration and displacement of the sprung mass by 16.8% and 21.4% respectively, compared with the passive system.
Student Teamwork During COVID-19: Challenges, Changes, and Consequences
Authors: Wildman Jessica L. , Nguyen Daniel M. , Duong Ngoc S. , Warren Catherine
Published: January 2021

The COVID-19 pandemic has greatly affected all of society, including teams in organizational settings. Collaborative teamwork is particularly susceptible to pandemic disruptions, as coordination across individuals becomes challenging in socially distanced and virtual contexts. Unfortunately, COVID-19 research thus far has primarily studied individual health and performance. Analysis of 90 open-ended survey responses gives voice to students working in project teams during the pandemic and provides future research directions regarding the multilevel impacts of the pandemic on teamwork. Results reflect three themes: (1) challenges experienced; (2) changes to team communication, tasks, and roles; and (3) consequences to team progress and outcomes.
Children’s Participation in Decision Making From Child Welfare Workers’ Perspectives: A Systematic Review
Authors: Toros Karmen
Published: January 2021

This article explores child welfare workers’ experiences of children’s participation in decision making in the child protection system. The systematic review follows the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and includes 12 peer-reviewed articles published in academic journals from 2009 to 2019. Findings indicate that children’s participation in decision making is generally limited or nonexistent. The age of the child is an important determining factor concerning whether the child is given the opportunity to participate in decision making. Potential harm for children that may result from participation is considered when deciding on whether to include a child in the decision-making process.
“But I Gathered My Courage”: HIV Self-Testing as a Pathway of Empowerment Among Ugandan Female Sex Workers
Authors: Wachinger Jonas , Kibuuka Musoke Daniel , Oldenburg Catherine E. , Bärnighausen Till , Ortblad Katrina F. , McMahon Shannon A.
Published: January 2021

HIV self-testing (HIVST) increases HIV testing in diverse populations, but little is known about the experiences of individuals who self-test. We used a five-step framework approach to analyze 62 qualitative interviews with 33 female sex workers (FSWs) participating in an HIVST trial in urban Uganda. Notions of empowerment emerged from the data, and findings were interpreted based on Kabeer’s empowerment framework of resources, agency, and achievements. We found that access to HIVST bolstered empowerment because it increased participant’s time and money (resources), control of testing circumstances and status disclosure (agency), and sense of competency (achievements). In addition, we found that knowledge of HIV status empowered participants to better control HIV-related behaviors (agency) and recognize a new sense of self (achievements). This suggests that the availability of HIVST can facilitate feelings of empowerment, meriting a higher awareness for benefits outside of linkage to HIV treatment and prevention services.
A Multicenter Retrospective Review of Systemic Anti-Cancer Treatment and Palliative Care Provided to Solid Tumor Oncology Patients in the 12 Weeks Preceding Death in Ireland
Authors: Mallett Victoria , Linehan Anna , Burke Orla , Healy Laura , Picardo Sara , Kelly Catherine M. , McCaffrey John , Carney Des , McDermott Ray , Walshe Janice , Kelleher Fergal , Higgins Stephen , Ryan Karen , Higgins Michaela J.
Published: January 2021

Background:

Systemic anti-cancer treatment (SACT) can improve symptoms and survival in patients with incurable cancer but there may be harmful consequences. Information regarding the use of SACT at the end-of-life and its impact on patients has not been described in Ireland.

Aims:

The study aimed to quantify and describe the use of SACT at end-of-life. The primary outcome of interest was the number of patients who received treatment in the last 12, 4 and 2 weeks of life. Secondary outcomes included the frequency of admissions and procedures, location of death, and timing of specialist palliative care (SPC) referral.

Methods:

Retrospective review. Fisher exact testing was used for analyses. Patients were included if they died between January 2015 and July 2017 and received at least 1 dose of treatment for a solid tumor malignancy.

Results:

Five hundred and eighty two patients were included. Three hundred and thirty eight (58%), 128 (22%) and 36 (6%) received treatment in the last 12, 4 and 2 weeks of life respectively. Patients who received chemotherapy in the last 12 weeks of life were more likely to be admitted to hospital, undergo a procedure, and die in hospital than those who did not (P < 0.001 for all). Median time of SPC referral before death was shorter in those patients who received chemotherapy than those who did not (61 v129 days, p = 0.0001).

Conclusion:

Patients who received chemotherapy had a higher likelihood of hospital admission, invasive procedure, and in-hospital death. They were less likely to have been referred early to SPC services.
Sociodemographic Disparities in Access to Hospice and Palliative Care: An Integrative Review
Authors: Nelson Katie E. , Wright Rebecca , Peeler Anna , Brockie Teresa , Davidson Patricia M.
Published: January 2021

Background:

There is growing evidence of disparities in access to hospice and palliative care services to varying degrees by sociodemographic groups. Underlying factors contributing to access issues have received little systematic attention.

Objective:

To synthesize current literature on disparities in access to hospice and palliative care, highlight the range of sociodemographic groups affected by these inequities, characterize the domains of access addressed, and outline implications for research, policy, and clinical practice.

Design:

An integrative review comprised a systematic search of PubMed, Embase, and CINAHL databases, which was conducted from inception to March 2020 for studies outlining disparities in hospice and palliative care access in the United States. Data were analyzed using critical synthesis within the context of a health care accessibility conceptual framework. Included studies were appraised on methodological quality and quality of reporting.

Results:

Of the articles included, 80% employed non-experimental study designs. Study measures varied, but 70% of studies described differences in outcomes by race, ethnicity, or socioeconomic status. Others revealed disparate access based on variables such as age, gender, and geographic location. Overall synthesis highlighted evidence of disparities spanning 5 domains of access: Approachability, Acceptability, Availability, Affordability, and Appropriateness; 60% of studies primarily emphasized Acceptability, Affordability, and Appropriateness.

Conclusions:

This integrative review highlights the need to consider various stakeholder perspectives and attitudes at the individual, provider, and system levels going forward, to target and address access issues spanning all domains.
An Exploratory Qualitative Study of Patient and Caregiver Perspectives of Ambulatory Kidney Palliative Care
Authors: Bristol Alycia A. , Chaudhry Sobaata , Assis Dana , Wright Rebecca , Moriyama Derek , Harwood Katherine , Brody Abraham A. , Charytan David M. , Chodosh Joshua , Scherer Jennifer S.
Published: January 2021

Objectives:

The ideal clinical model to deliver palliative care to patients with advanced kidney disease is currently unknown. Internationally, ambulatory kidney palliative care clinics have emerged with positive outcomes, yet there is limited data from the United States (US). In this exploratory study we report perceptions of a US-based ambulatory kidney palliative care clinic from the perspective of patient and caregiver attendees. The objective of this study was to inform further improvement of our clinical program.

Methods:

Semi-structured interviews were conducted to elicit the patient and caregiver experience. Eleven interviews (8 patients with chronic kidney disease stage IV or V and 3 caregivers) were analyzed using qualitative description design.

Results:

We identified 2 themes: “Communication addressing the emotional and physical aspects of disease” and “Filling gaps in care”; Subthemes include perceived value in symptom management, assistance with coping with disease, engagement in advance care planning, program satisfaction and patient activation.

Significance of Results:

Qualitative analysis showed that attendees of an ambulatory kidney palliative care clinic found the clinic enhanced the management of their kidney disease and provided services that filled current gaps in their care. Shared experiences highlight the significant challenges of life with kidney disease and the possible benefits of palliative care for this population. Further study to determine the optimal model of care for kidney palliative care is needed. Inclusion of the patient and caregiver perspective will be essential in this development.
“It Felt Like I Had Air Back in My Lungs”: Eleanor’s Journey Back From Burnout
Authors: Paetz Allison M.
Published: January 2021

The purpose of this narrative inquiry was to explore the story of a secondary ensemble teacher who experienced burnout and chose to remain in the profession. Eleanor and I met for three semistructured interviews and two observations. I used Clandinin and Connelly’s three-dimensional inquiry space as a framework for this study. Narrative analysis revealed that Eleanor experienced symptoms of burnout during a first teaching position that was a poor fit for her. Her passion and enthusiasm for teaching were reignited during a period of long-term music substitute teaching in a successful program surrounded by a supportive community. The importance of recognizing burnout, finding support systems, and identifying hegemonic assumptions about teaching emerged as critical points in Eleanor’s narrative. This arc became visible through narratively coding the field texts, and thoroughly reviewing data obtained from interviews and observations.
The Role of Nursing in the School Setting to Lead Efforts to Impact Child Trafficking: An Integrative Review
Authors: Doiron Megan L. , Peck Jessica L.
Published: January 2021

Registered professional and advanced practice nurses in the school setting, as a specialized practice entity, are leaders in implementation of evidence-based practice, skilled coordinators of care, advocates for students, and experts in designing systems assisting individuals and communities to reach full potential. Child trafficking (CT) is an emerging public health threat impacting safety and well-being of students present in the school setting. This literature review identified four themes in five studies: (1) training impacts nurses’ knowledge, awareness, and attitudes; (2) school nursing is underrepresented in training, education, prevention, response, and research; (3) lack of collaboration exists between school staff and school nurses; and (4) formal education and length of experience impact levels of interventions school nurses are able to provide. School nurses are opportunely situated to intervene as advocates for vulnerable children to develop a coordinated, effective response to CT risk factors, mitigating risk and fostering resiliency with systems-based change.
My Research Is My Story: A Methodological Framework of Inquiry Told Through Storytelling by a Doctor of Philosophy Student
Authors: Parter Carmen , Wilson Shawn
Published: January 2021

This article uses an Indigenous Research Methodology known as Storywork. Following Indigenous protocols and pedagogy through the telling of stories, the reader and listener is introduced to an Indigenist paradigm and research standpoint. Through describing my standpoint, the stories demonstrate the centrality of my Indigeneity in my methodology while also confirming an Indigenizing framework of inquiry. The stories highlight decisions and actions of government that have dismantled cultures and knowledge systems but can also be applied to public policy to enable and embed culture. Critical reflections within the stories depict Indigenous ways of being, knowing, and doing in research.
Mental Health Consequences of Intimate Partner Violence Against Women in El Salvador
Authors: Navarro-Mantas Laura , de Lemus Soledad , Megías Jesús L.
Published: January 2021

Violence against women (VAW) is currently one of the main problems in El Salvador, which leads the ranking of femicides in the world. We conducted the first national survey on VAW in El Salvador following the World Health Organization (WHO) methodology, to determine the impact of violence on women’s mental health ( N = 1,274). Women who had experienced intimate partner violence showed significantly poorer mental health and more suicidal ideations. Common mental disorders were significantly associated with the experience of all forms of violence, after adjusting for sociodemographic variables and stressful life experiences. The results are discussed in connection with the primary care protocols and the design of public policies.
Delayed immune thrombocytopenia after discontinuation of nivolumab therapy: A case report and literature review
Authors: Fu Shengya , Wang Ting , Xu Feng
Published: January 2021

Introduction

Nivolumab, a programmed death-1(PD-1) inhibitor antibody, have demonstrated anti-tumor activity for multiple malignancies. Such immune checkpoint inhibitors induce novel and distinctive adverse effects, which are collectively named immune-related adverse events. Immune-related adverse events can theoretically occur at any part of the body, including the haemopoietic system. Most immune-related adverse events developed within 10 weeks of receiving immunotherapy. Thus far, there is no report of immune thrombocytopenia as an immune-related adverse event developed after discontinuation of immunotherapy.

Case report

We describe a 62-year-old male with metastatic non-small cell lung cancer developed immune thrombocytopenia nearly two months after discontinuation of nivolumab. When thrombocytopenia was detected, the patient was undergoing radiotherapy of supraclavicular lymph nodes. After complex diagnosis-by-exclusion process, nivolumab-induced immune thrombocytopenia was diagnosed.

Management and outcome

Intravenous immunoglobulins 20 g daily for 5 days, intravenous methylprednisolone 40 mg daily for 14 days followed by oral prednisone, intermittent platelet transfusion and oral thrombopoietin receptor (eltrombopag 25 mg daily) were administered. After 30 days, his platelet count had achieved a level of adequate hemostasis and continued to improvement during the tapering period.

Discussion

Most immune-related developed 6 months of immunotherapy. Clinicians need to be aware of a clinical diagnostic complex, developing months to years after discontinuation of immunotherapy, which recently is termed delayed immune-related events. This case is the first report of immune checkpoint inhibitors-induced thrombocytopenia that developed nearly 2 months after discontinuation of treatment with nivolumab for metastatic NSCLC. In future clinical practice, patients who have received immune checkpoint inhibitors develop new or unexplained symptom, irrespective of interval post-immunotherapy, immune-related adverse events should be considered.
Comparison of four immunoassays to an HPLC method for the therapeutic drug monitoring of methotrexate: Influence of the hydroxylated metabolite levels and impact on clinical threshold
Authors: Descoeur Juliette , Dupuy Anne-Marie , Bargnoux Anne-Sophie , Cristol Jean-Paul , Mathieu Olivier
Published: January 2021

Objectives

Methotrexate requires therapeutic drug monitoring in oncology because of narrow therapeutic index, especially the metabolite 7-hydroxymethotrexate exhibits nephrotoxicity. The goal of this study was to evaluate different assays and their impact on clinical decisions.

Methods

Following routine measurement with Abbott TDxFLx® assay (MTX-TDX), 62 samples were analysed on Architect®i1000 (MTX-ARCHI), Xpand® (ARK/XPND), Indiko® (ARK/INDI), and HPLC (MTX-HPLC) as the reference method. The influence of 7-hydroxymethotrexate was explored on ARK reagent to document the cause of the observed bias. ROC curves were built to study the impact of the method on the discharge thresholds for the patients at three levels.

Results

Total imprecision was below 2.60% for the methotrexate-ARCHI and close to 10% for both ARK assays for plasma pools. The correlation coefficients were 0.93, 0.93, 0.89 and 0.95, the Bland–Altman difference plot revealed a bias of 0.075, 0.037, 0.049 and –0.002, and the number of results exceeding the TE criteria of 0.1 µM was 17 (27%), 13 (21%), 15 (24%) and 15 (24%) for MTX-TDX, ARK/INDI, ARK/XPND and MTX-ARCHI, respectively. Cross reactivity with 7-hydroxymethotrexate was between 1 and 9%. Overestimation of methotrexate concentration was between –4% and +32%. The most robust clinical level was found to be the highest level (0.2 µM) with ROC curves.

Conclusions

The authors found the best results for imprecision with chemiluminescent microparticle immunoassay method on methotrexate-ARCHI, with bias below to the RICOS recommendations and best correlation to the reference method. Impact on the threshold values for clinical decision need to be clearly exposed to clinicians.
Knowledge assessment and barriers to cancer screening among Ghanaian community pharmacists
Authors: Mensah Kofi B , Mensah Adwoa Bemah Boamah , Yamoah Peter , Attakorah Joseph , Bangalee Varsha , Oosthuizen Frasia
Published: January 2021

Introduction

Though there are controversies, cancer screening has been suggested to decrease mortality. Over the years, the most accessible primary healthcare provider; the community pharmacist, has developed an interest in being part of cancer screening activities and prevention of a wide range of other non-communicable diseases. To achieve this, community pharmacists need a working knowledge of the basic screening test and recommendations. Also, it’s important to acknowledge the barriers that may prevent the implementation of cancer-screening efforts at the community pharmacy. This study aims to determine the knowledge and barriers to cancer screening among Ghanaian community pharmacists.

Methodology

Knowledge and barriers to cancer screening was assessed using an online questionnaire in 435 community pharmacists. Descriptive statistics and Pearson's chi-squared tests were used to analyze the data.

Results

The reliability and validity assessment of the questionnaire after data collection revealed a Cronbach’s alpha value of 0.82 for knowledge on cancer screening. The SD and mean age of study participants were 2.48 ± 20.08. Only 25.7% of the participants had good knowledge. The most identified barrier was the lack of established guidelines (60.9%). There was no association between participants' demographics and their knowledge scores.

Conclusions

Community pharmacists can potentially have a large impact on early detection of cancer through screening. However, they have to improve their knowledge on general screening guidelines and be aware of available educational resources to increase their knowledge. It is also important for all stakeholders to come together to establish local screening modalities and recommendations for the country.
Sensitivity and specificity of drug interaction databases to detect interactions with recently approved oral antineoplastics
Authors: Bossaer John B , Eskens Danielle , Gardner Austin
Published: January 2021

Rationale:

Drug-drug interactions (DDIs) with oral antineoplastics (OAs) are of increasing concern given the rapid increase in OA approvals and use in cancer patients. A small pilot study of 20 DDIs with OAs showed significant variability in commonly used DDI screening databases in sensitivity of detecting potentially clinically relevant DDIs. This study builds upon that work by expanding the number of potential DDIs analyzed and including a specificity analysis.

Methods

Newly approved OAs from 2016 to May 2019 (n = 22) were included in this analysis. Prescribing information for each drug was reviewed. A list of explicit and theoretical drug interactions was created for each OA by the two investigators. A board-certified oncology pharmacist adjudicated all DDI pairs for potential clinical significance. In total, 229 DDI pairs were used to analyze sensitivity of 5 DDI databases (Lexicomp®, Micromedex®, Medscape, Eporactes®, & Drugs.com). Additionally, 64 “dummy” or false DDI pairs were created to analyze specificity. Sensitivity and specific were analyzed using Cochran’s Qtest, while accuracy was analyzed using chi-square test.

Results

There was significant variability among the databases with regards to sensitivity (p < 0.0001), specificity (p < 0.0001), and accuracy (p < 0.0001). In terms of accuracy (max score = 400), Lexicomp®(355), Epocrates® (344), and Drugs.com (352) scored higher than MicroMedex® (270) and Medscape (280).

Conclusions

Considerable variability exists among DDI screening databases with regards to OAs and potential drug interactions. Clinicians should be vigilant in both screening for DDIs with OAs and describing DDIs encountered in clinical practice.
Clinical controversies in the treatment of cancer-associated venous thromboembolism
Authors: Nachar Victoria R , Schepers Allison J
Published: January 2021

Cancer-associated venous thromboembolism (VTE) is a common complication of malignancy. Patients with cancer exhibit risk factors for both recurrent VTE and major or minor bleeding. Direct oral anticoagulants (DOACs) are an attractive treatment option; however, there is a lack of consensus among national guidelines for choice between DOACs and LMWH, agent selection, dosing strategy, and duration of anticoagulation. Characteristics of the thrombotic event, the malignancy, the patient, and the anticoagulant must be considered. A systematic search of online databases was performed to identify literature on the management of cancer-associated VTE. Multiple controversies remain surrounding the optimal treatment of cancer-associated VTE.
Vancomycin pharmacokinetic parameters in patients undergoing hematopoietic stem cell transplantation
Authors: Arjangpour Samareh , Sadeghi Kourosh , Solduzian Mohammad , Mousavi Seied Asadollah
Published: January 2021

Introduction

Current guidelines on vancomycin dosing lack specific recommendations about its dosing in hematopoietic stem cell transplant (HSCT) patients, the objective of the current study was to compare vancomycin pharmacokinetic variables in this population with those of general population.

Methods

A prospective study was designed and the calculated parameters of vancomycin pharmacokinetic were compared with individualized parameters. Two trough levels before 4th and 5th doses and a peak level after the 4th dose, were taken. All patients received a dose of 15 mg/kg of vancomycin two or three times a day. Pharmacokinetic parameters were calculated using a one compartmental model. The association between different variables and of acute kidney injury (AKI) development and achievement of target levels were also evaluated.

Results

A significant difference was observed between population Volume of distribution (Vd) and individualized Vd (mean 57.33 L vs 162.86 L, p value 0.019) and trough and peak levels (p values 0.0001 and 0.001; for mean trough and peak levels respectively). The achievement of the recommended trough levels and area under the concentration time curve per minimum inhibitory concentration (AUC24/MIC) was very low (5/71 and 24/71 patients respectively). No significant differences were observed between population and individualized clearance and rate of elimination of vancomycin (p values of 0.092 and 0.55 respectively). Concomitant receipt of cyclosporine was significantly related with development of AKI (p value 0.046).

Conclusion

The dosing methods which use population-based pharmacokinetic variables does not result in desired therapeutic levels in HSCT patients, mainly because of larger vancomycin volume of distribution.
Evaluating the incidence of chemotherapy-induced nausea and vomiting in patients with B-cell lymphoma receiving dose-adjusted EPOCH and rituximab
Authors: Uchida Emma , Lei Matthew M , Roeland Eric , Lou Uvette
Published: January 2021

Background

Studies evaluating antiemetic prophylaxis have primarily focused on the solid tumor setting and single-day regimens. This study evaluates antiemetic prophylaxis and chemotherapy induced nausea and vomiting (CINV) in patients with lymphoma receiving a multiday doxorubicin-cyclophosphamide containing regimen.

Methods

This was a retrospective, single center, cohort study evaluating patients with aggressive non-Hodgkin B-cell lymphoma receiving dose-adjusted R-EPOCH in the hospital. Data was collected from the electronic medical record from April 2016 to September 2019. Complete response over 120 hours was the primary outcome. Secondary outcomes included complete response during the acute and delayed phases as well as complete control.

Results

A total of 73 patients who received dose adjusted R-EPOCH were identified. Most patients (n = 39, 53%) were male with a the median age was 63 years (range: 21–81). Most patients received ondansetron 16 mg once daily (n = 48, 66%) on days 1–5 as antiemetic prophylaxis with a minority receiving either dexamethasone (n = 8) or an NK1 antagonist (n = 13) in addition to ondansetron. Complete response rate was 32% and the complete response in the acute and delayed phase was also 32%.

Conclusion

Control of CINV in patients with lymphoma hospitalized to receive dose-adjusted R-EPOCH was suboptimal, with only 32% of patients achieving complete response. Nearly three-quarters of patients received only a 5HT3 receptor antagonist as scheduled antiemetic therapy without an NK1 receptor antagonist. This data supports the importance of improving awareness of regarding multiday CINV guidelines and ensuring timely update and implementation of these evidence-based guidelines.
Reducing the Use of Mechanical Restraints in the Medical–Surgical Department
Authors: Adekanmi Oluwakemi Bamidele
Published: January 2021

BACKGROUND:

The most crucial discussion in psychiatric hospitals is the safety of patients, especially during incidents that have the potential to cause physical harm such as those where mechanical restraints are used.

AIM:

The goal of the project was to reduce the use of mechanical restraints by 25% within 10 weeks in two piloted medical–surgical units.

METHOD:

A total of 60 articles were examined for relevance; out of these, the author used 30 studies that were based on observational, literature review, quantitative analysis, or clinical trial methodologies to conduct a comprehensive literature review. The author used a retrospective and descriptive design of chart review data collection to implement the project. The six core strategies framework, coupled with the creation of mental health championship role, was implemented to mitigate the problem.

RESULTS:

This study shows that the implementation of the six core strategies and the role of a mental health champion helped reduce the use of mechanical restraints by 100%.

CONCLUSION:

A total of 3,072 patients’ charts were reviewed in which there were three PERT (Psychiatric Emergency Response Team) activation and no mechanical restraint events, which showed a considerable quality improvement compared to the pre-implementation data collection of 37 PERT and 14 mechanical restraint events. The implications for practice and further study in the field are the involvement of more authors with similar expertise, the use of a control group for comparison, and a longer length of study duration.
Revalorized broccoli by-products and mustard improved quality during shelf life of a kale pesto sauce
Authors: Castillejo Noelia , Martínez-Hernández Ginés Benito , Artés-Hernández Francisco
Published: January 2021

The effect of revalorized Bimi leaves (B) and/or mustard (M) addition, as supplementary ingredients, to develop an innovative kale (K) pesto sauce was studied. Microbial, physicochemical (color, total soluble solids content -SSC-, pH and titratable acidity –TA-) and sensory quality were studied during 20 days at 5 °C. Bioactive compounds changes (total phenolics, total antioxidant capacity and glucoraphanin contents) were also monitored throughout storage. The high TA and pH changes in the last 6 days of storage were avoided in the K+B pesto when adding mustard, due to the antimicrobial properties of this brassica seed. SSC was increased when B + M were added to the K pesto, which positively masked the kale-typical bitterness. Mustard addition hardly change yellowness of the K pesto, being not detected in the sensory analyses, showing K+B+M pesto the lowest color differences after 20 days of shelf life. The addition of Bimi leaves to the K pesto enhanced its phenolic content while mustard addition did not negatively affect such total antioxidant compounds content. Finally, mustard addition effectively aimed to glucoraphanin conversion to its bioactive products. Conclusively, an innovative kale pesto supplemented with Bimi by-products was hereby developed, being its overall quality well preserved up to 20 days at 5 °C due to the mustard addition.
#TripleNegativeBreastCancer on Instagram
Authors: Henderson Alesha , Miller Carrie A. , Sutton Arnethea L. , Guidry Jeanine P. D.
Published: January 2021

Little is known about how triple negative breast cancer (TNBC) is discussed on the visual social media platform, Instagram. A greater understanding of the experiences of TNBC survivors that are documented on this platform may inform us of how this group of survivors cope with this rare, but aggressive form of breast cancer. This study analyzed a random sample ( N = 501) of Instagram posts using the hashtag #triplenegativebreastcancer. Using a quantitative content analysis, posts were coded for the presence of health belief model constructs as well as the presence of treatment-related experiences, social support, and hereditary breast cancer genetic mutations (BRCA 1/2). Our findings suggest that health organizations and agencies are not utilizing Instagram as a conduit of health communications about TNBC to reach individuals worldwide. This article provides insights into potential strategies that can be used by these entities to promote user engagement with posts about TNBC, such as utilizing health messaging that is episodic in nature, uses supportive and encouraging words, and provides information about chemotherapy.
α-Melanocyte-Stimulating Hormone Triggers Melanogenesis Via Activation of the Aryl Hydrocarbon Receptor Pathway in B16F10 Mouse Melanoma Cells
Authors: Bahraman Ali Ghaffarian , Jamshidzadeh Akram , Keshavarzi Majid , Arabnezhad Mohammad-Reza , Mohammadi Hamidreza , Mohammadi-Bardbori Afshin
Published: January 2021

Melanin is a group of natural pigments that determines the human skin color and provides fundamental protection against the harmful impacts of physical and chemical stimuli. The aim of this study was to establish the regulatory role of aryl hydrocarbon receptor (AhR) in α-melanocyte-stimulating hormone (α-MSH) induced melanogenesis. In the present study, following knockdown of AhR, murine B16F10 cells were treated with α-MSH (200 nM) and tyrosinase activities, cellular melanin content, mRNA levels of several important genes involved in melanogenesis including AhR, CTNNB1, TYR2, and microphthalmia-associated transcription factor ( MITF) were measured as endpoints. Exposure to α-MSH led to elevated expression of AhR, CTNNB1, MITF, and TYR in accordance with increased tyrosinase enzyme activity as well as a significant rise in the total melanin content. Our results suggest that AhR plays a regulatory role in α-MSH-stimulated melanogenesis.
A History of Board Certification in Pediatric Pathology on Its 30th Anniversary
Authors: Goldstein Jeffrey D. , Parham David M.
Published: January 2021

In 1983 under the leadership of Dr. Daria Haust, the Pediatric Pathology Club (PPC; forerunner of the Society for Pediatric Pathology [SPP]), promulgated bylaws that included recognition of the special expertise required in pediatric pathology. This standard followed formal discussion that began as early as 1970, suggesting that special certification should be pursued, and the idea was vetted by the PPC in 1980 following a special report by Dr. Benjamin Landing and a letter to PPC members. Under the leadership of Dr. William Donnelly in 1984, a relationship between the SPP and the American Board of Pathology (ABPath) began in order to receive recognition of pediatric pathology as a special discipline. As a result, a test committee chaired by Dr. Jerald Schenken began preparing question categories and examples for ABPath examination. These efforts culminated in the first pediatric pathology subspecialty examination, held in Atlanta, Georgia on November 20, 1990. With this article we wish to detail the history of ABPath pediatric pathology board certification from its beginnings to the current time.
Principal–Agent Relationship Within a Cruise Supply Chain Model for China
Authors: Chu Angela Mai Chi , Hsu Cathy H. C.
Published: January 2021

Changes in travelers’ booking habits and the evolution of technology have come to threaten the existence of traditional travel agents (TAs). However, the cruise industry still relies heavily on TAs as its main distribution channel. A qualitative study was conducted to investigate the networks, relationships, and power distribution between cruise companies and TAs using a triangulation method via a tourism supply chain model. Principal–agent (P-A) theory was taken as the framework to describe various parties’ relationships and roles. Several TA business models were identified, including group blocks (i.e., guaranteed and nonguaranteed) and charter cruises (i.e., retail for resale and corporate; meetings, incentives, conferences, and exhibitions). Results show an imbalance of power between parties due to unique business practices and customer preferences in Mainland China. Principals (i.e., cruise companies) were found to rely excessively on agents (i.e., TAs) to create demand, with the growing number of cruise lines leading agents to overpower principals. The alliance among TAs further affected the principal–agent relationship. A refined tourism supply chain model tailored to the cruise industry is thus proposed herein; this cruise supply chain model simplifies the complicated business network relationships between cruise companies and TAs in China.
Legal “Locker Room Talk”: Essentialist Discourses of Masculinity in Law*
Authors: Hatton Erin
Published: January 2021

In this article, I examine how legal actors construct masculinity in law, even in cases that have seemingly little to do with gender. I analyze 118 recent cases in which lawyers, witnesses, and/or judges use gendered expressions, such as “locker room talk,” as a key element of their legal strategy, testimony, or decision-making. By identifying the specific behaviors to which these legal actors refer when they describe something as “locker room talk,” I develop a typology of the narrow, essentialist, and predominantly violent forms of masculinity that are deployed—and normalized—in contemporary U.S. law.
Understanding Migrant Masculinities through a Spatially Intersectional Lens
Authors: Wojnicka Katarzyna , Nowicka Magdalena
Published: January 2021

This article analyzes migrant narratives on masculinity through an intersectional perspective that is sensitive to spatial aspects. Drawing on research with migrants in Berlin and Munich in Germany, we unpack how (self-identified) Polish men in these cities negotiate their gender identities vis-à-vis other people whom they perceive as ethnic, religious, gender, and sexual others. We address how their social and ethnic backgrounds shape their narratives on foreign masculinities and femininities at the intersection of ethnicity and gender. In particular, we draw attention to how these negotiations are entangled with local discourses over the presence and visibility of various immigrant groups and cosmopolitan queer communities in the cities. The intersectional approach helps us to formulate how masculine identities change within the context of migration.
Teaching Board Game Play to Young Children With Disabilities
Authors: Trimlett Gabrielle M. , Barton Erin E. , Baum Caroline , Robinson Gabriela , Schulte Lauren , Todt Mollie
Published: January 2021

We examined the use of an intervention package consisting of the system of least prompts (SLP), visual schedules, peer models, and contingent reinforcement to teach four children with disabilities to independently play board games and communicate with their typically developing peers. We found the intervention package with individual adaptations was related to increases in independent board game play behaviors. No changes in peer-directed social communication were observed. Our study extends the research on board game play–focused interventions by demonstrating the effectiveness of the intervention package for young children with or at risk for disabilities and their typically developing peers.
Experience level as a predictor of entry into the hypotympanum during feline total ear canal ablation and lateral bulla osteotomy
Authors: Mehrkens Lea R , Townsend Katy L , Cooley Stacy D , Milovancev Milan , Newsom Lauren E
Published: January 2021

Objectives

The study hypotheses were as follows: (1) owing to the unique anatomy of the feline middle ear, the hypotympanum would be entered in less than 100% of cats during total ear canal ablation and lateral bulla osteotomies (TECA-LBOs); and (2) incomplete penetration of the septum and subsequent failure to enter the hypotympanum is more likely to occur in surgeries performed by a novice surgeon when compared with an experienced surgeon and may be under-recognized.

Methods

Head CT was performed in 12 feline cadavers to confirm absence of gross ear disease. A novice surgeon and an experienced surgeon were randomly assigned to perform TECA-LBO on the left or right ear. Surgeons were blinded to each other’s surgical technique. CT of cadavers was performed after the procedure. Successful penetration of the septum, entry into the hypotympanic cavity and amount of bone removed in bulla osteotomy, quantified via CT, were compared between the novice surgeon and experienced surgeon.

Results

The novice surgeon entered the hypotympanum in 3/12 (25%) procedures, compared with 9/12 (75%) procedures performed by the experienced surgeon. The experienced surgeon performed a larger osteotomy than the novice surgeon (3301 mm vs 1376 mm, P <0.0023). Regardless of surgeon experience, more bone was removed in surgeries in which the hypotympanum was entered.

Conclusions and relevance

Our results underscore the need for familiarity with feline middle ear anatomy when performing TECA-LBOs. Postoperative CT is recommended for novice surgeons to confirm entry into the hypotympanum.