bluuebunny/crossref_metadata_2025 huggingface dataset:
Active Non-alignment and Global Governance
Authors: Heine Jorge
Published: August 2024

Countries in Latin America and the Caribbean—but also, more broadly, across the Global South—are being subjected to pressures from Washington and Beijing to take sides in what is emerging as a Second Cold War. How should countries in Africa, Asia, and Latin America react to this ? The purpose of this essay is to outline one response that has arisen to it in Latin America; namely, Active Non-Alignment (ANA). The essay first examines the concept of ANA. Then, it deals with the reaction elicited across the Global South to the war in Ukraine, in what many have referred to as a “new non-alignment”. Finally, the essay examines the case of India, seen by many as a leader of the Global South, and Africa. ANA provides a useful guide to action for the foreign policy of postcolonial states to navigate the stormy waters of a world order in transition.
Relevance and Reform
Authors: Ungar Maya
Published: August 2024

The United Nations is at a point of legitimacy crisis, particularly from members of the so-called Global South who have long felt underrepresented by the institution. Walking through recent debates around trust and reform of the UN system, this article provides an analysis of the UN’s crisis of confidence and what can be done to reduce it. First, the article connects research on trust theories of international relations to the legitimacy and effectives of the UN. Second, it overviews recent debates about representation in the UN system, and provides an analysis of their feasibility built off of desk research and first-person interviews with diplomats and relevant sources. Results found that the UN is attempting to adapt to remain relevant, but the institution is quickly losing the trust of its membership because of its inability to evolve quickly enough.
NATO as a Military OECD
Authors: Breitenbauch Henrik
Published: August 2024

While increased strategic competition poses a challenge to the global governance agenda writ large, the concomitant increased demand for security is in principle a boon to international security governance’s prime exemplar, NATO. Adding insights from international policy diffusion to the agenda of strategic competition, this article proposes that NATO supports the alliance’s primary, external function of deterrence and defense by providing strategic epistemic capital to its members through meditative and inquisitive forms of governance. These ensure that member nations keep abreast of the evolving best practice of defense and military affairs, and underpin overall convergence of defense policies and military practices, from consensus-based strategic wayfinding to tactical interoperability on the battlefield. Crucially, the alliance is also a brokerage of strategic sensemaking. Seeing NATO through the prism of an international organization like the Organisation for Economic Co-operation and Development thus deepens our understanding of how the alliance functions as well as of its resilience.
The Treatment of Civil Wars in a Fragmenting International Order
Authors: Gowan Richard
Published: August 2024

In 2018, the author and Stephen John Stedman posited the existence of a post-Cold War “standard treatment” for civil wars based on mediation and peacekeeping, often implemented through the United Nations. Other scholars have questioned how durable this treatment proved to be, suggesting that it lost traction as the United States and other powers opposed mediation involving jihadist groups. Growing major power tensions further undermined the use of the treatment. Nonetheless, states and international organizations still use elements of the mediation-peacekeeping package in responding to civil wars, suggesting that it is adaptable or at least “sticky” enough to outlast the circumstances in which it first emerged. This article explores the evolution and after-lives of the standard treatment for civil wars and asks what may follow it.
Multilateral Climate Governance
Authors: Baumann Franz
Published: August 2024

For nearly half a century, negotiations in the context of the United Nations Framework Convention on Climate Change have sought to reduce pressures on nature without curtailing the North’s wealth or thwarting the South’s economic development. Since the 1992 Rio Earth Summit, science has become more granular, the global economy has grown phenomenally, greenhouse gas emissions and temperature rises have accelerated rather than slowed, the climate crisis and inequality have become more extreme, and the status quo interests have become more entrenched. After three lost (wasted, rather) decades, climate mitigation is terribly urgent, yet hugely contested. Choices are stark: financing mitigation and adaptation, or stomaching immense suffering.
Commentary
Authors: Pham Minh-Thu
Published: August 2024

This commentary addresses the challenges and opportunities of renewing multilateral cooperation, including at the UN Summit of the Future. It argues that despite pessimism given global political divisions, significant potential exists for reform. Recent successes demonstrate the efficacy of networked multilateralism, in which coalitions of states supported by nongovernmental organizations played pivotal roles. The piece suggests such coalitions can help Member States renew the multilateral system based on fair representation, increased contributions from emerging powers, shared responsibility among major powers, and inclusion of nongovernmental actors. It emphasizes the need for world leaders to address pressing challenges and restore trust in multilateral systems by showing they can deliver fair, inclusive, and effective solutions. The author offers a framework to guide global governance reform—which defends the old, governs the new, strengthens the borrowed, and renews the blue—and ensure the UN remains a relevant and central body in global governance.
The Multilateral Foreign Policies of Rising States in the Global South
Authors: Braveboy-Wagner Jacqueline Anne
Published: August 2024

As countries formerly deemed to be “developing” and relatively powerless begin to exert more influence in global arenas, fresh attention is being paid by Western policymakers as well as scholars to the possibility of the creation of a multipolar system that is shaping up to be a highly diverse one. To assess whether this incipient multipolarity can be sustained, it is important to examine the evolving diplomatic strategies of the nations of the Global South, in particular their reliance on multilateral mechanisms for normative guidance and tangible gains. This requires an examination of the content of the foreign policies of current and potential leading nations of the Global South, not only those that are fortunate enough to exert influence at the global level, but also those that are in key positions at the regional and subregional levels. A study of selected leading countries found that organizational membership and leadership, regionalism, nonalignment, multialignment, and agility in adopting and operationalizing norms such as South-South cooperation and environmentalism are among the key strategies that are being employed by Global South states in their efforts to gain visibility in global affairs.
The Question of Non-Independent Apex Courts as Effective Remedies to be Exhausted
Authors: Leloup Mathieu
Published: August 2024

This article discusses the question of whether non-independent apex courts should be considered effective remedies that must be exhausted before lodging a complaint before the European Court of Human Right (Court). It first analyses the special position of domestic apex courts in the European Convention on Human Rights (echr) framework and argues that a domestic court cannot be considered an effective remedy if it is not duly independent. Then, it shows how the Court has so far evaded taking a clear position on this issue. Finally, the article argues that the Court should deal with such issues of independence under the exhaustion criterion. It shows how such an approach is in line with existing case law and corresponds to the logic inherent in Article 35 echr. In doing so, the Court would, moreover, stress the systemic importance of domestic judicial independence for the proper functioning of a subsidiary Convention mechanism.
Sensitivity to Vibrotactile Stimulation in the Hand and Wrist: Effects of Motion, Temporal Patterns, and Biological Sex
Authors: Tajdari Mahdis , Forsyth Jason , Lim Sol
Published: August 2024

Objective

We investigated the impact of low-tempo, repetitive hand movements on vibrotactile sensitivity by employing various temporal and spatial patterns in the hand and wrist area.

Background

The investigation of a human’s ability to perceive vibrotactile stimuli during dynamic hand movements remains understudied, despite the prevalence of slow to mild hand motions in applications such as hand navigation or gesture control using haptic gloves in Virtual Reality (VR) and Augmented Reality (AR).

Method

We investigated vibrotactile sensitivity, analyzing the impact of various factors, including Motion (static and low-tempo repetitive hand movements), Temporal Patterns (Single or Double vibrations with varying onset times), Tactor Placements (hand and wrist), Spatial Patterns, and Biological Sex.

Results

Our study revealed that Motion significantly influences vibrotactile sensitivity in the hand and wrist areas, leading to reduced accuracy rates during dynamic conditions. Additionally, as the stimulus onset approached in Double vibrations, accuracy rates markedly decreased. Notably, Hand Placement resulted in significantly higher accuracy rates compared to the Wrist Placement.

Conclusion

Our findings underscore the impact of motion in reducing vibrotactile sensitivity on the back of the hand and around the wrist.

Application

This research has wide-ranging practical applications, particularly in the field of VR/AR experiences, rehabilitation programs, and accessibility solutions through the use of haptic gloves. Insights from our study can be harnessed to enhance the efficacy of haptic gloves in conveying vibrotactile cues within these contexts.
Research on the reaction mechanism and control of aluminium enhancement for electroslag remelting high-quality turbine blade steel
Authors: Yan Wen-hao , Geng Xin , Jiang Zhou-hua , Liu Fu-bin
Published: August 2024

Based on laboratory experiments and thermodynamic analysis, this article reveals the reaction mechanism behind the increase in aluminium content during the electroslag remelting (ESR) process in a protective atmosphere. It investigates the effects of slag composition, steel composition, reaction temperature, and reaction atmosphere on the aluminium content in ingots to inhibit the increase of aluminium during the remelting process. The results indicate that the increase in aluminium content is accompanied by significant silicon loss in the steel and an increase in silicon dioxide in the slag. The aluminium content in the ingots is controlled by the thermodynamic reaction equilibrium between [Si] in the steel and (Al2O3) in the slag. The high-temperature conditions during the ESR process promote the occurrence of the aluminium addition reaction. In the ESR process without a protective atmosphere, the oxidation of the consumable electrode in air forms a ferrous oxide, leading to a decrease in silicon activity. Consequently, the trend of aluminium increase in ingots remelted in a nonprotective atmosphere is lower than that in ingots remelted in a protective atmosphere. Increasing the silicon dioxide content in the slag to 1.96%–7.62% is an effective approach to inhibit aluminium addition in the ingot. However, excessive addition of silicon dioxide can cause the burning loss of alloy elements and increase the content of silicate inclusions. Additionally, reducing the initial silicon content in the electrode from 0.55% to 0.40% further reduces the aluminium content in the ingot. Industrial experiments were conducted using the optimised S2 slag system (68.63% CaF2–19.61% Al2O3–4.90% CaO–4.90% MgO–1.96% SiO2). The results were consistent with laboratory experiments, and the aluminium content in the ingots met the standard requirements.
Effective Treatment of Methotrexate Induced Oral Mucositis With a Morphine Mouthwash Solution: A Case Report
Authors: Hosseini Raha , Brooks Shelby P. , Gadelha Elissa , Schaap Riley , Cook Jessica , Husan Ammar
Published: August 2024

Introduction: Methotrexate (MTX) is a common medication used to treat rheumatoid arthritis (RA). MTX inhibits rapid cell turnover throughout the body which can lead to significant side effects. Patients who present with oral lesions may have suffered severe acute toxicity from MTX. Supportive pain treatment includes magic mouthwash solution and/or oral viscous lidocaine to manage pain and allow for healing. We report a case of MTX induced oral mucositis that did not respond to magic mouthwash but did improve with a morphine mouthwash solution. Case: A 67-year-old female with RA presented with worsening oral lesions over 2 weeks. She reported non-compliance with folic acid for 2 weeks while on MTX. Physical exam revealed ulcerating oral lesions on the mucous membranes consistent with mucositis. Pain treatment was initiated with magic mouthwash, but her pain was not well controlled after 24 hours, and still unable to swallow. An oral morphine mouthwash solution was initiated, and patient reported improved pain control over the next 48 hours. She was on the morphine mouthwash for 6 days during which improvement in the lesions was noted. Discussion: Pain management is imperative for oral mucositis. When traditional therapies do not provide adequate control, morphine mouthwash can be considered. It is a safer alternative to systemic opioids and topical opioids may influence cell proliferation and migration, which can positively impact healing of oral lesions. Conclusion: A morphine mouthwash solution can provide effective pain management for oral mucositis lesions in patients who do not respond adequately to magic mouthwash.
Attaining Sustainability via Shrimad Bhagavad Gita: An Empirical Study of Identified Variables, Self-Efficacy, Goal Performance and Leadership Effectiveness
Authors: Dubey Pushkar , Joshi Amit , Mishra Ramesh Chandra
Published: August 2024

The pursuit of a meaningful and purposeful existence has consistently been a universal human aspiration, even in the field of business. Individuals seek significance in every endeavour they undertake. In line with this notion, the Shrimad Bhagavad Gita (SBG) directs individuals towards the path of truth and purpose. The present study attempts to examine the effect of SBG-identified variable entitled as ‘Theory of Work’ or ‘Karma’ (consisting of no desire for fruit (NDF), non-attachment (NA), deterministic intellect (DI), righteous duty (RD), success and failure as equal (SAF)) on self-efficacy (SE) among teachers in higher educational institutions (HEI) in India. It also aims to find the association between SE and goal performance and leadership effectiveness among the teachers of HEI. A judgemental sampling procedure was adopted to collect the data from HEI clustered across five different zones in the country. A total of 600 responses were collected through an online-administered questionnaire. The analysis results indicated that theory of work variables (i.e., NDF, DI, NA and RD) have a significant positive effect on SE, and SE positively affects the goal performance and leadership effectiveness. However, treating SAF as equal variables was not found to have a significant effect on SE.
Impacts of Disability Duration and Physical Activity Level on Wheelchair Propulsion Strategies in People with T12/L1 Spinal Cord Injury
Authors: Hong San , Kim Hyunji , Ahn Jooeun , Park Woojin
Published: August 2024

This study explores the impact of disability duration and physical activity (PA) level on wheelchair propulsion in individuals with T12/L1 spinal cord injury (SCI). It involves eleven participants with complete T12/L1 SCI, as per the American Spinal Injury Association Impairment Scale A. They executed propulsion at maximum and self-selected speeds, with measurements of shoulder, elbow, wrist, and trunk angles, and electromyography (EMG) data from upper body muscles. Using a one-way ANOVA and a Tukey post hoc test, the study assessed the effects of disability duration and PA level on propulsion kinematics and muscle activity. Findings reveal significant influences of disability duration on elbow motion range and biceps activity, and of PA level on trunk displacement and upper trapezius activity. The study emphasizes the need to consider broader factors in assessing variability of wheelchair propulsion strategies for SCI individuals.
Doing the Right Thing in Advertising: Moral Education and Training
Authors: Schauster Erin
Published: August 2024

Undergraduate students showed an increase in moral reasoning (DIT) after a semester-long course covering topics of advertising ethics, completing a new advertising ethics training program (CEAE), and engaging in activities that allowed for reflection. Students placed more importance on postconventional stages of moral reasoning over personal interest despite the suggestion that emerging adults are self-focused. Students agreed or strongly agreed that studying ethics is important to developing moral awareness and moral reasoning and found the professional training relevant to their critical thinking skills and moral awareness. Advertising education should continue to use reflection and role-taking activities and consider incorporating professional training and future research should continue to explore the role of moral motivation in moral reasoning.
Comparing DOAC and warfarin outcomes in an obese population using the ‘real-world’ Michigan Anticoagulation Quality Improvement Initiative (MAQI2) registry
Authors: Ardeshna Nelish , Feldeisen Thane , Kong Xiaowen , Haymart Brian , Kaatz Scott , Ali Mona , Barnes Geoffrey D , Froehlich James B
Published: August 2024

Introduction:

Direct oral anticoagulants (DOACs) have overtaken warfarin in the treatment of nonvalvular atrial fibrillation (AF) and venous thromboembolism (VTE). Limited data explore the safety of DOACs in obesity.

Methods:

This multicenter retrospective study between June 2015 and September 2019 uses the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) registry to compare DOACs and warfarin across weight classes (not obese: body mass index (BMI) ⩾ 18.5 and < 30; obese: BMI ⩾ 30 and < 40; severely obese: BMI ⩾ 40). Primary outcomes include major, clinically relevant nonmajor (CRNM), and minor bleeding events per 100 patient-years. Secondary outcomes include stroke, recurrent VTE, and all-cause mortality.

Results:

DOACs were prescribed to 49% of the 4089 patients with AF and 46% of the 3162 patients with VTE. Compared to patients treated with warfarin, those treated with DOACs had a higher estimated glomerular filtration rate across BMI categories regardless of indication. In the AF population, severely obese patients treated with DOACs had more major (3.4 vs 1.8, p = 0.004), CRNM (8.6 vs 5.9, p = 0.019), and minor bleeding (11.4 vs 9.9, p = 0.001). There was no difference in stroke or all-cause mortality. In the VTE population, both CRNM (7.5 vs 6.7, p = 0.042) and minor bleeding (19.3 vs 10.5, p < 0.001) events occurred at higher rates in patients treated with DOACs. There was no difference in recurrent pulmonary embolism, stroke, or all-cause mortality.

Conclusion:

There is a higher rate of bleeding in severely obese patients with VTE and AF treated with DOACs compared to warfarin, without a difference in secondary outcomes. Further studies to compare the anticoagulant classes and understand bleeding drivers in this population are needed.
The relationship between fatigue, exercise self-efficacy, fear of movement, and quality of life in patients with heart failure: A moderated mediation model
Authors: Zhang Xiuting , Fang Wenjie , Zhang Yilin , Yang Mei , Wang Mei , Fan Xiuzhen
Published: August 2024

This study was aimed to examine the moderated mediating effects of exercise self-efficacy and fear of movement on the relationship between fatigue and quality of life in patients with heart failure. A total of 305 patients with heart failure were enrolled in this cross-sectional study. The results showed that fear of movement significantly mediated the relationship between fatigue and quality of life, indicating that relieving fear of movement may be beneficial to improve quality of life. Furthermore, exercise self-efficacy negatively moderated the mediating effect of fear of movement on the relationship between fatigue and physical health-related quality of life. It is suggesting that improving exercise self-efficacy may provide opportunities to buffer the negative effect of fear of movement on physical health-related quality of life in patients with heart failure, especially for those with fatigue. The findings provide additional strategies to optimize quality of life management in patients with heart failure.
He said, she said
Authors: Cefai Sarah
Published: August 2024

In recent years, popular feminist discourse has increasingly associated feminism with a cultural concept of consent. My reflection in this special section of Cultural Commons: ‘#(No)SeAcabó / It is (not) over’ discusses the Rubiales/Hermoso kiss through the lens of consent by enquiring into how the words ‘he said, she said’ attend to particular kinds of gender injustice. I suggest that ‘he said, she said’ acts as a form of representation that has the effect of reifying the cultural experience of nonconsent as an experience of relations of power. By critically assessing ‘he said, she said’ as a narrative device, we can further understand the role of representation in obscuring our encounter with and critical enquiry into the event, which I suggest we foreground in our discussions of what ‘she said’.
Threat or menace to media pluralism? A framework to assess alternative conspiracy media in today’s information landscape
Authors: Urkens Jolan , Harambam Jaron , d’Haenens Leen
Published: August 2024

In this article, we examine recent changes in Western media landscapes that witnessed the emergence of alternative conspiracy media critiquing the epistemic hegemony of legacy media, and explore ways to analyze whether they contribute to or hinder democratic discourse. This pressing question depends not only on the empirical manifestations of such media outlets, but also on the ideal conceptualization of media pluralism, which is contingent upon the preferred democratic theory. In this article, we draw from and build upon the work of Daniëlle Raeijmaekers and Pieter Maeseele, and develop a framework to systematically compare media practices against different democratic ideals/theories. We conceptualize a set of criteria that are crucial for the functioning of democracy given each democratic line of thought. Focusing on the three most important contemporary schools – liberal, deliberative, and agonistic – we argue that evaluations of media practices should consider three concepts especially important for media’s functioning in democracy: actor diversity, discursive diversity, and epistemological diversity. We have developed a comparative framework designed for systematic evaluations of media practices, assessing their contribution to media pluralism. This framework may be useful for scholars and media practitioners when assessing the democratic potential of new alternative (conspiracy) media.
Can Ayurveda medicine supplement modern medical treatments in chronic disease management?
Authors: Ravindran Vyshna , Kumar Kanta , Bhandari Sunil , Chattopadhyay Kaushik , Payyappallimana Unnikrishnan , Morandi Antonio , Gupta Rajeev
Published: August 2024

The editorial highlights the fact that there is limited communication between healthcare providers and patients about complementary and integrative medicine (TCI) like Ayurveda. To address this, healthcare professionals need better education on Ayurveda. Additionally, international collaborations can enhance research and credible information, ensuring safe and effective patient care.
Efficacy and Safety of Anlotinib in EGFR-Positive Patients with Advanced Lung Adenocarcinoma Compared with Chemotherapy: A Retrospective Study
Authors: Cai Cuihong , Shen Qian , Shao Jingjing , Qu Jingjing , Zhou Shuangshuang , Zhou Jianya
Published: August 2024

There are no standard third-line or beyond treatments for patients with driver mutation-positive advanced lung adenocarcinoma (LUAD). Anlotinib was approved as a third-line multitarget drug in China in 2018. Limited data are available regarding the efficacy and safety of anlotinib compared with chemotherapy. To investigate the efficacy and safety of anlotinib compared with traditional chemotherapy in patients with epidermal growth factor receptor (EGFR)-positive advanced LUAD. We conducted a retrospective study of 83 EGFR mutation-positive patients with advanced LUAD between 2011 and 2022. Progression-free survival (PFS) and overall survival (OS) were the primary endpoints, whereas the objective response rate (ORR) and disease control rate (DCR) were the secondary endpoints. Anlotinib-related adverse events (AEs) were recorded to evaluate the safety of anlotinib. 39 patients with LUAD received anlotinib and 44 patients with LUAD received chemotherapy were enrolled in the study. Patients treated with anlotinib exhibited longer PFS (11.2 vs 4.5 months, P < .01) and OS (18.8 vs 15.8 months, P < .05) than patients treated with chemotherapy. There were no significant differences in ORR (7.9% vs 20.5%, P = .129) or DCR (100% vs 93.2%, P = .120) between the two groups. Anlotinib-related AEs grading 3-4 level were observed in 2 (5.1%) patients, no anlotinib-related death was recorded. Cox regression analyses of PFS and OS showed that brain metastases and age < 30 years at diagnosis had negative effects on clinical outcomes. Anlotinib is effective and safe in patients with EGFR-positive advanced LUAD. Patients without brain metastases had better clinical outcomes.
Application of Continuous Care Pattern Based on Information-Motivation-Behavioral Skills Model in out-of-Hospital Rehabilitation of Diabetic Foot Ulceration Patients: A Randomized Controlled Trial
Authors: Zhao Zhenxue , Xu Wenchao , Wang Suxia , Zhang Dandan , Wang Yuqi
Published: August 2024

Objective

To explore the effect of information-motivation-behavioral skills model (IMB)-based continuous nursing model on the out-of-hospital rehabilitation of diabetic foot ulceration (DFU) patients, and to provide a theoretical basis for long-term disease management of DFU patients.

Methods

A total of 88 patients with DFU admitted to our Hospital were included in this prospective study. The patients were divided into control and study groups using the random number table method, with 44 cases in each group. Patients in the study group received both routine care and IMB-based continuing care, and the control group received only routine care.

Results

At week 1, FBS, PBG (2 h) and HbA1c were significantly decreased in the study group compared with that in the control group ( P < .05). At week 3 and 6, blood glucose indicators were significantly improved in both groups compared with week 1 ( P < .05). In additional, the number of non-infected patients at week 1 and week 3 in the study group was significantly higher than that in the control group ( P < .05). At week 3, the number of cured patients was significantly higher in the study group than that in the control group ( P < .05). And the area of ulcer healing in the study group was significantly larger than that in the control group at week 1 and week 3 ( P < .05).

Conclusion

In conclusion, the continuous nursing mode based on IMB can help DFU patients manage blood glucose level, reduce wound infection, and accelerate wound healing, which is worthy of wide clinical application and promotion.
The prospective association between psychological strengths and incident musculoskeletal injury in active duty Army soldiers
Authors: Vie Loryana L , Ho Tiffany E , Whittaker Kerry S , Hawkins Jacob
Published: August 2024

Extensive training, overuse, overexertion, and repetitive movements put Soldiers at increased risk for musculoskeletal injuries (MSIs). The present study investigated the prospective association between psychological strengths, physiological and social factors, and non-combat-related MSI in a sample of 24,746 active duty Army Soldiers. Over a mean follow-up period of 21.07 months (SD = 16.07), 65.42% of the Soldiers examined were treated for an MSI. Applying survival analysis techniques and adjusting for relevant physiological and social factors, we found greater baseline Optimism, Positive Affect, Coping, and Adaptability were each associated with a modest reduction in risk of MSI (4-8%). Additionally, being older, female, married, and having a higher BMI were each associated with an increased MSI risk, whereas being an officer (relative to enlisted) and obtaining post-secondary education were each associated with a decreased MSI risk. Future research should examine the mechanisms through which psychological-based interventions may impact Soldiers’ risk of MSI.
Quality of life is impaired in myelin oligodendrocyte glycoprotein antibody associated disease
Authors: Said Yana , Ladakis Dimitrios C , Lefelar Julia M , Khazen Jenny M , Gould Jennifer , Fitzgerald Kathryn C , Sotirchos Elias S
Published: August 2024

Background

There is a paucity of studies examining quality of life (QoL) in people with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).

Methods

A cross-sectional, online, self-administered survey was distributed. Data elements included demographic and clinical characteristics, and QoL in Neurological Disorders (Neuro-QoL) short form questionnaires. Neuro-QoL domain scores were compared to reference populations, yielding standardized T-scores. Symptom severity was categorized as mild, moderate, or severe, using standard Neuro-QoL cut points.

Results

A total of 259 participants completed the survey. Neuro-QoL domain impairment was present in a significant proportion of respondents (anxiety: 58.1%, depression: 30.7%, stigma 29.8%, cognition: 58.5%, social function: 57.7%). T-scores were significantly worse than the reference population for anxiety (p<0.001), stigma (p=0.005), cognitive function (p<0.001) and social interactions (p<0.001). There was no clear association between QoL domains and demographics, disease-modifying therapy class, or type of clinical presentation. A relapsing vs monophasic disease course was associated with worse anxiety, stigma, cognition, and social interactions (p<0.05).

Conclusion

People with MOGAD may exhibit impairment in multiple domains of QoL. Practicing clinicians should be aware of this burden in MOGAD. Further research is needed to better understand factors associated with QoL impairment in MOGAD.
“#My Place Isn’t in the Kitchen”: Examining Feminist Facebook Framing of an Algerian Social Movement
Authors: Chaif Rim H. , Finneman Teri
Published: August 2024

This study examines the dynamics of a social media campaign launched by Algerian feminists in 2018 in response to a video shared on Facebook that narrated a woman’s upsetting encounter with harassment. This movement occurred in a region often known for its autocratic systems of governance and the prevalence of its Islamic movements rather than for its prominence of feminist advocacy. Yet the Global South and particularly North Africa are actually abundant with women’s rights organizations, a fact often overlooked in both Western scholarship and media. Drawing from social movement theory, this research analyzes how feminists in the Global South strategically presented their narratives on Facebook by employing diagnostic, prognostic, and motivational framing approaches. The findings illuminate that Algerian feminists primarily used two collective action frames in their messaging: diagnostic to increase awareness and prognostic to suggest long-term solutions. Yet motivational framing to empower supporters and give them a rationale to get involved was less prioritized, creating a critical gap in sustaining the movement and turning online grievances into action.
Matters We Metric Vs. Metrics that Matter
Authors: Onizuka Naoko , Sinvani Liron , Quatman Carmen
Published: August 2024

Introduction

Geriatric fracture is a pressing global health issue, marked by elevated mortality and morbidity rates and escalating health care costs. The evolving health care system from fee-for-service to quality-based reimbursement has led to externally driven reward and reimbursement systems that may not account for the complexity of caring for older adults with fracture.

Significance

The aim of this review is to highlight the need for a shift towards meaningful metrics that impact geriatric fracture care and to issue a call to action for all medical societies to advocate for national reimbursement and ranking systems that focus on metrics that truly matter.

Results

Traditional metrics, while easier to capture, may not necessarily represent high quality care and may even have unintentional adverse consequences. For example, the focus on reducing length of stay may lead to older patients being discharged too early, without adequately addressing pain, constipation, or delirium. In addition, a focus on mortality may miss the opportunity to deliver compassionate end-of-life care. Existing geriatric fracture care metrics have expanded beyond traditional metrics to include assessment by geriatricians, fracture prevention, and delirium assessments. However, there is a need to further consider and develop patient-focused metrics. The Age-Friendly Health Initiative (4 Ms), which includes Mobility, Medication, Mentation, and what Matters is an evidence-based framework for assessing and acting on critical issues in the care of older adults. Additional metrics that should be considered include an assessment of nutrition and secondary fracture prevention.

Conclusion

In the realm of geriatric fracture care, the metrics currently employed often revolve around adherence to established guidelines and are heavily influenced by financial considerations. It is crucial to shift the paradigm towards metrics that truly matter for geriatric fracture patients, recognizing the multifaceted nature of their care and the profound impact these fractures have on their lives.
Determinants of Online Live Esports Viewership With Advanced Data: The Case of League of Legends Champions Korea
Authors: Ryu Yoonji , Jeong Jaehyun , Jang Wonseok , Lee Gyemin , Pyun Hyunwoong
Published: August 2024

With the rapid advancement of technology, esports have become more accessible and widespread on online platforms. The behavior of fans watching live broadcasts online differs from that of those watching on TV or attending stadium events. To understand the online demand for esports, this study examines the determinants of live esports viewership using advanced data from online platforms. We examined game-level data from the League of Legends Champions Korea (LCK) from the summer of 2019 to the summer of 2022. We analyzed four dependent variables representing esports online demands—hours watched, peak views, concurrent average views, and view drops—based on several pre-game (outcome uncertainty and team quality), in-game (game quality and upset result), and schedule-related (evening game) variables. Using two-way least squares dummy variable regression models, we identified the key determinants. The results suggest that outcome uncertainty, team quality, game quality, and evening games significantly impact esports online viewership. In addition, in-game factors, such as the sum and difference in kills between teams, attracted more viewers. This indicates that online viewers prefer games with more kills and a closer kill difference between teams.
A case of adnexal cutaneous leishmaniasis in Washington DC
Authors: Akosman Sinan , Song Heeyah , Sheils Paul , Mansour Tamer , Wroblewski Keith J. , Rajjoub Lamise
Published: August 2024

Purpose

To report a rare non-endemic case of Leishmania aethiopica in Washington DC.

Case report

A 68-year-old female presented for a routine examination with a complaint of right upper eyelid lesions for the past 5 months. On examination, a cluster of elevated and erythematous lesions extending from the medial canthus to the brow area of the right eye were seen. Initial treatment with Valtrex based on a suspected viral etiology failed. Although a biopsy was recommended at this time, the patient declined, and subsequent workup included nasolacrimal duct irrigation, blood work to rule out autoimmune etiology, a course of doxycycline, and an MRI, which yielded no improvement. Upon progression of the lesions into persistent plaques on the eyelids, a punch biopsy was performed, confirming leishmaniasis. The patient was then started on a 28-day course of oral miltefosine which led to complete resolution of her symptoms.

Conclusion

This case underlines the importance of a broad differential including non-endemic diseases, particularly in urban areas with frequent patient travel. Furthermore, the delayed punch biopsy in this case highlights the importance of patient counseling to ensure prompt diagnosis and treatment.
Antagonist anti-LIF antibody derived from naive human scFv phage library inhibited tumor growth in mice
Authors: Zhao Shengyan , Deng Han , Lu Ying , Tao Yiran , Li David , Jiang Xiaohua , Wei Xian , Chen Xiaofeng , Ma Fanxin , Wang Yuxi , Gou Lantu , Yang Jinliang
Published: August 2024

Background

Leukemia inhibitory factor (LIF) is a multifunctional member of the IL-6 cytokine family that activates downstream signaling pathways by binding to the heterodimer consisting of LIFR and gp130 on the cell surface. Previous research has shown that LIF is highly expressed in various tumor tissues (e.g. pancreatic cancer, breast cancer, prostate cancer, and colorectal cancer) and promotes cancer cell proliferation, migration, invasion, and differentiation. Moreover, the overexpression of LIF correlates with poor clinicopathological characteristics. Therefore, we hypothesized that LIF could be a promising target for the treatment of cancer. In this work, we developed the antagonist antibody 1G11 against LIF and investigated its anti-tumor mechanism and its therapeutic efficacy in mouse models.

Results

A series of single-chain variable fragments (scFvs) targeting LIF were screened from a naive human scFv phage library. These scFvs were reconstructed in complete IgG form and produced by the mammalian transient expression system. Among the antibodies, 1G11 exhibited the excellent binding activity to human, cynomolgus monkey and mouse LIF. Functional analysis demonstrated 1G11 could block LIF binding to LIFR and inhibit the intracellular STAT3 phosphorylation signal. Interestingly, 1G11 did not block LIF binding to gp130, another LIF receptor that is involved in forming the receptor complex together with LIFR. In vivo, intraperitoneal administration of 1G11 inhibited tumor growth in CT26 and MC38 models of colorectal cancer. IHC analysis demonstrated that p-STAT3 and Ki67 were decreased in tumor tissue, while c-caspase 3 was increased. Furthermore, 1G11 treatment improves CD3+, CD4 + and CD8 + T cell infiltration in tumor tissue.

Conclusions

We developed antagonist antibodies targeting LIF/LIFR signaling pathway from a naive human scFv phage library. Antagonist anti-LIF antibody exerts antitumor effects by specifically reducing p-STAT3. Further studies revealed that anti-LIF antibody 1G11 increased immune cell infiltration in tumor tissues.
CD19 CAR T cells for B cell malignancies: a systematic review and meta-analysis focused on clinical impacts of CAR structural domains, manufacturing conditions, cellular product, doses, patient’s age, and tumor types
Authors: Montagna Erik , de Campos Najla Santos Pacheco , Porto Victoria Alves , da Silva Giselle Correia Próspero , Suarez Eloah Rabello
Published: August 2024

CD19-targeted chimeric antigen receptors (CAR) T cells are one of the most remarkable cellular therapies for managing B cell malignancies. However, long-term disease-free survival is still a challenge to overcome. Here, we evaluated the influence of different hinge, transmembrane (TM), and costimulatory CAR domains, as well as manufacturing conditions, cellular product type, doses, patient’s age, and tumor types on the clinical outcomes of patients with B cell cancers treated with CD19 CAR T cells. The primary outcome was defined as the best complete response (BCR), and the secondary outcomes were the best objective response (BOR) and 12-month overall survival (OS). The covariates considered were the type of hinge, TM, and costimulatory domains in the CAR, CAR T cell manufacturing conditions, cell population transduced with the CAR, the number of CAR T cell infusions, amount of CAR T cells injected/Kg, CD19 CAR type (name), tumor type, and age. Fifty-six studies (3493 patients) were included in the systematic review and 46 (3421 patients) in the meta-analysis. The overall BCR rate was 56%, with 60% OS and 75% BOR. Younger patients displayed remarkably higher BCR prevalence without differences in OS. The presence of CD28 in the CAR’s hinge, TM, and costimulatory domains improved all outcomes evaluated. Doses from one to 4.9 million cells/kg resulted in better clinical outcomes. Our data also suggest that regardless of whether patients have had high objective responses, they might have survival benefits from CD19 CAR T therapy. This meta-analysis is a critical hypothesis-generating instrument, capturing effects in the CD19 CAR T cells literature lacking randomized clinical trials and large observational studies.
Coverage of policies to improve antimicrobial stewardship in human medicine in low and middle income countries: results from the Global Survey of Experts on Antimicrobial Resistance
Authors: Zay Ya Kyaw , Lambiris Mark J. , Levine Gillian A. , Tediosi Fabrizio , Fink Günther
Published: August 2024

Background

Antimicrobial resistance (AMR) constitutes a major threat to global health. While antimicrobial misuse or overuse is one of the main drivers for AMR, little is known about the extent to which antibiotic misuse is due to a lack of national government-led efforts to enforce rational use in low and middle-income countries (LMICs).

Methods

To assess antimicrobial stewardship and national implementation measures currently in place for optimizing antimicrobial use and for slowing the spread of AMR, we invited public health experts from 138 LMICs to participate in a Global Survey of Experts on Antimicrobial Resistance (GSEAR). Key coverage measures, as reported by experts, were compared across countries and also juxtaposed with estimates collected in the 2020-21 World Health Organization-organized Tripartite AMR Country Self-Assessment Survey (TrACSS).

Results

A total of 352 completed surveys from 118 LMICs were analysed. Experts in 67% of the surveyed countries reported a national action plan (NAP) on AMR, 64% reported legislative policies on antimicrobial use, 58% reported national training programs for health professionals, and 10% reported national monitoring systems for antimicrobials. 51% of LMICs had specific targeted policies to limit the sale and use of protected or reserve antibiotics. While 72% of LMICs had prescription requirements for accessing antibiotics, getting antibiotics without a prescription was reported to be possible in practice in 74% of LMICs. On average, country efforts reported in TrACSS were substantially higher than those seen in GSEAR.

Conclusions

In many LMICs, despite the existence of policies aimed at slowing down the spread of AMR, there are still significant gaps in their implementation and enforcement. Increased national efforts in the areas of enforcement and monitoring of antibiotic use as well as regular monitoring of national efforts are urgently needed to reduce inappropriate antibiotic use in LMICs and to slow the spread of AMR globally.
Domestic, family and sexual violence polyvictimisation and health experiences of Australian nurses, midwives and carers: a cross-sectional study
Authors: McLindon Elizabeth Veronica-Mary , Spiteri-Staines Anneliese , Hegarty Kelsey
Published: August 2024

Background

Domestic, family and sexual violence is a prevalent health and social issue. Nurses may be exposed to higher rates of this violence in their personal lives compared to the community, but little is known about their polyvictimisation experiences or health and well-being impacts.

Methods

An online descriptive, cross-sectional survey of women nurses, midwives and carer members of the Australian Nursing and Midwifery Federation (ANMF) (Victorian Branch) (response rate: 15.2% of nurses sent an invitation email/28.4% opened the email). Violence survey measures included: intimate partner violence (Composite Abuse Scale); child abuse and sexual violence (Australian Bureau of Statistics Personal Safety Survey items). Health measures included: Short Form-12; Fast Alcohol Screening Test; Patient Health Questionnaire-4; Short Screening for DSM-IV Posttraumatic Stress Disorder; well-being measures included: Connor-Davidson Resilience Scale, social support, and financial stress. Proportions were used to describe the prevalence of violence by sociodemographic characteristics and health and well-being issues; logistic regression predicted the odds of experiencing overlapping types of violence and of experiencing health and well-being outcomes.

Results

5,982 participants (from a parent study of 10,674 nurses, midwives and carers) had experienced at least one type of lifetime violence; half (50.1%) had experienced two or three types (polyvictimisation). Survivors of child abuse were three times more likely to experience both intimate partner violence and non-partner adult sexual assault. Any violence was associated with poorer health and well-being, and the proportion of affected participants increased as the types of violence they had experienced increased. Violence in the last 12-months was associated with the poorest health and well-being.

Conclusions

Findings suggest a cumulative, temporal and injurious life course effect of domestic, family and sexual violence. The polyvictimisation experiences and health and well-being associations reported by survivor nurses, midwives and carers underscores the need for more accessible and effective workplace interventions to prevent and mitigate psychosocial ill health, especially in the recent aftermath of violence.