bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Consanguineous Marriage on Children’s Human Capital in Pakistan
Authors: Chaudhry Theresa , Arif Rabia
Published: November 2023

Cousin marriage is an important social institution in many parts of Asia and Africa; yet few studies have looked beyond the health consequences to its role in shaping intrahousehold dynamics. We use a unique survey of households in Pakistan to examine the role of parental consanguinity on education, child work and vaccination, and how those effects differ by gender. We apply ordinary least squares, Tobit, inverse probability weighting with regression adjustment treatment effects and intent-to-treat estimation techniques to a dataset of 1,020 households from 9 districts and control for a rich set of covariates. We model selection into consanguineous marriage using the availability of opposite-gender marriageable cousins. Our results show that the adult children of parents who are first cousins completed fewer years of education and are less likely to have attended school. Educational attainment was curtailed equally for daughters of both marriage arrangements, but consanguineous daughters faced a double burden of consanguinity and gender discrimination. For school-aged children of consanguineous couples, the number of days of school missed is higher in some specifications, but enrolment and educational expenditures are roughly the same as children of parents who are not related or are related more distantly. In contrast, domestic work is somewhat reduced for the offspring of first-cousin parents. Daughters of consanguineous parents are less likely to have received vaccinations, although this effect is weaker in the sample of school-aged children than adult children.
Availability and Readability Level of Online Patient Education Materials Provided by Cleft Lip and Palate Teams
Authors: Powell Lauren E. , Bien Erica M. , Cohen Jade M. , Barta Ruth J.
Published: November 2023

Objectives

Evaluate the readability of online English and Spanish cleft lip and palate patient education materials.

Design

Review of free online materials

Setting

English and Spanish language online patient education materials on cleft lip and palate were collected from American Cleft Palate-Craniofacial Association (ACPA) approved teams.

Participants

American Cleft Palate-Craniofacial Association (ACPA) approved teams

Interventions

English materials were analyzed using the Flesch-Kincaid, SMOG, and Coleman-Liau readability calculators. Spanish materials were analyzed using the Fry Graph, Fernandez Huerta, and INFLESZ calculators. A one-way analysis of variance (ANOVA) was used to test for variability between the readability tools.

Outcomes

Readability levels were examined for both sets of materials.

Results

171 (90.5%) teams provided English language materials online, with an average readability score calculated as 10.5 ± 2.9 (10th-11th grade). A total of 44 (23.2%) teams listed Spanish language materials online, with average readability score of 7.9 ± 1.2 (8th grade). ANOVA demonstrated statistically significant variability between the readability assessment tools ( P < .01).

Conclusion

Online cleft lip and palate patient education material provided by ACPA craniofacial teams were more available in English than in Spanish. Both sets of materials demonstrated readability levels above the recommended 6th-7th grade. Refining readability is associated with lowered healthcare costs and increased patient satisfaction.
Eating Disorder Examination-Questionnaire: Norms for Adults in Higher Levels of Care
Authors: Rienecke Renee D. , Mehler Philip S. , Duffy Alan , Le Grange Daniel , Peterson Carol B. , Blalock Dan V.
Published: November 2023

Establishing normative data for questionnaires is essential for the accurate interpretation of scores, given that these norms can vary according to different subpopulations and treatment contexts. The purpose of this study was to establish norms for the Eating Disorder Examination-Questionnaire (EDE-Q) among adults receiving higher levels of care (HLOCs) for the treatment of eating disorders. Participants were 2,283 people receiving treatment at the inpatient, residential, partial hospitalization, or intensive outpatient levels of care. The EDE-Q was completed at admission. Patients with anorexia nervosa—restricting subtype (AN-R) had the lowest EDE-Q Global scores when compared with all other eating disorder diagnoses. When compared with intensive outpatient care, only those in residential treatment had higher EDE-Q Global scores. This study is among the first to describe norms for the EDE-Q in a large sample of adults receiving various HLOCs. Programs utilizing the EDE-Q to assess treatment outcomes can use these findings to aid people in interpreting their scores.
Enhancing post-harvest quality of sapota using ultraviolet-C irradiation: A study on efficacy and effects
Authors: Singh Charan , Kumar Nitin , Joshi Nirav Umeshbhai , Popaliya Chandani , Kumar Ravi , Ramani Maulik , Neha  , Kumar Vikash
Published: November 2023

Ultraviolet-C (UV-C) radiation has been identified as a promising method for enhancing the shelf life of fruits and vegetables by reducing microbial count and boosting their defence mechanisms. In this study, the impact of UV-C radiation on the physical, biochemical, and microbial properties of sapota fruits was investigated by subjecting them to different doses (2.5, 5, 7.5, and 10 kJ m−2; 12 ± 1°C; 85–90% relative humidity) to enhance their shelf life. The results revealed that higher doses of UV-C radiation resulted in significantly lower weight loss and higher firmness compared to untreated samples and samples treated with lower doses. Furthermore, UV-C-treated fruits displayed a delayed increase in total soluble solids, total sugar, and reduced sugar content compared to the untreated fruit during storage. The UV-C-treated fruits also exhibited a delayed decline in ascorbic acid and titratable acidity during storage. The treated fruits exhibited significantly higher phenolic content than the untreated fruits. Additionally, significantly lower decay and microbial count were observed in fruits treated with higher doses than in those treated with lower doses. The samples treated with a dose of 7.5 and 10 kJ m−2 had a shelf life of 25 days compared to 14 days for the control fruits.
Framing Water Infrastructure for Climate Resilience: Governance Dimensions and Challenges
Authors: Fisk Jonathan M. , Harris Paul A. , Kuks Stefan M. M. , Morris John C. , Vinke-De Kruijf Joanne
Published: November 2023

As the effects of climate change become more acute, the search for solutions to a growing infrastructure crisis becomes increasingly important. In this commentary, we offer some approaches to guide our collective thinking about the importance of governance regimes related to water infrastructure, as well as a framework for ways to think about infrastructure solutions that move beyond traditional “gray” solutions to more natural solutions that can serve to increase resiliency to climate change.
Cerebellar pathology in multiple sclerosis and experimental autoimmune encephalomyelitis: current status and future directions
Authors: Maxwell Dain L. , Orian Jacqueline M.
Published: November 2023

Recent decades have witnessed significant progress in understanding mechanisms driving neurodegeneration and disease progression in multiple sclerosis (MS), but with a focus on the cerebrum. In contrast, there have been limited studies of cerebellar disease, despite the common occurrence of cerebellar symptoms in this disorder. These rare studies, however, highlight the early cerebellar involvement in disease development and an association between the early occurrence of cerebellar lesions and risk of worse prognosis. In parallel developments, it has become evident that far from being a region specialized in movement control, the cerebellum plays a crucial role in cognitive function, via circuitry connecting the cerebellum to association areas of the cerebrum. This complexity, coupled with challenges in imaging of the cerebellum have been major obstacles in the appreciation of the spatio-temporal evolution of cerebellar damage in MS and correlation with disability and progression. MS studies based on animal models have relied on an induced neuroinflammatory disease known as experimental autoimmune encephalomyelitis (EAE), in rodents and non-human primates (NHP). EAE has played a critical role in elucidating mechanisms underpinning tissue damage and been validated for the generation of proof-of-concept for cerebellar pathological processes relevant to MS. Additionally, rodent and NHP studies have formed the cornerstone of current knowledge of functional anatomy and cognitive processes. Here, we propose that improved insight into consequences of cerebellar damage in MS at the functional, cellular and molecular levels would be gained by more extensive characterization of EAE cerebellar pathology combined with the power of experimental paradigms in the field of cognition. Such combinatorial approaches would lead to improved potential for the development of MS sensitive markers and evaluation of candidate therapeutics.
Learning to facilitate student voice in primary physical education
Authors: Cardiff Grace , Beni Stephanie , Fletcher Tim , Bowles Richard , Chróinín Déirdre Ní
Published: November 2023

Student voice pedagogies in physical education (PE) offer teachers a mechanism to promote meaningful experiences by actively engaging students in decision-making regarding their learning. Over one academic year, the experiences of one generalist classroom teacher's enactment of student voice pedagogies in their primary PE practice were explored within a Self-Study of Teaching and Teacher Education Practice (S-STTEP) frame. Data sources included post-lesson personal reflections, a researcher journal, and transcripts from meetings with a critical friend. Qualitative data was also collected from students ( n = 19) over a shorter timeframe of six months, and took the form of student work samples, along with transcripts from focus group interviews ( n = 2, with eight total participants). Findings show that the enactment of student voice pedagogies requires significant scaffolding for both the teacher and their students. The teacher needs to learn how to listen to, nurture, and act on their students’ voices, while students require assistance in developing their capacity to share their voices. Thus, the enactment of student voice pedagogies takes time, and necessitates a period of trial and error, to ensure the educator is providing authentic student voice opportunities in their practice. This study adds an additional layer to student voice research by providing a teacher's perspective of learning how to enact student voice pedagogies in PE. Furthermore, the findings add to the limited research into the use of student voice pedagogies at primary level.
The Glasgow miracle? Storytelling, violence reduction and public policy
Authors: Fraser Alistair , Gillon Fern
Published: November 2023

The city of Glasgow, once dubbed the ‘murder capital of Europe’, has more recently become famed for its experiments in violence reduction. In this article, based on a large-scale study of violence reduction, we focus on the discursive construction of this so-called ‘Glasgow miracle’. Based on interviews with 40 senior stakeholders working in Scotland during the period 2000–2020, we explore the significance of dramatic personal stories of tragedy, redemption, and rebirth in shifting the public narrative around violence. In so doing, we contribute new empirical and theoretical evidence to narrative criminology, demonstrate the conditions under which progressive policies can come to the fore, and interrogate the role of storytellers in communicating these stories with persuasion and influence.
Unpacking the exclusionary rule of repeated confessions in China
Authors: Mou Luye , Chen Li
Published: November 2023

While Chinese law recognises that repeated confessions following an initial confession procured by illegal means should be excluded from trial, the legal doctrine by which China excludes such evidence differs significantly from other jurisdictions. China's approach to the exclusion of repeated confessions is premised on what this paper loosely terms a ‘principle plus exceptions’ model, in which a general exclusionary rule for repeated confessions is supplemented with a closed list of exceptions. A study of the 113 cases on China Judicial Documents Network highlights the difficulties in the operationalisation of the ‘principle plus exceptions’ model, with the result that the law on repeated confessions is inconsistently applied. In response, this paper proposes that China should adopt a flexible and open-ended case-specific analysis, whereby courts examine the admissibility of the repeated confession based on the circumstances of each case and various factors. In the end, this paper advocates for essential institutional reforms aimed at bolstering the judicial authority of the Chinese judiciary and facilitating the advancement of evidence law reform in China.
Use of service robots in hospitality: An observational study in terms of technology acceptance model
Authors: Çalişkan Gürkan , Sevim Burhan
Published: November 2023

This study aims to explore hospitality customers’ behavioral intentions and reactions toward service robots from the perspective of the Technology Acceptance Model. Kastamonu University Scientific Research Projects Coordination Department has supported this research. In this context, the service robot was leased. The service robot has been shown to customers in the lobbies, restaurants, rest areas, and cafes of accommodation establishments. Customers were enabled to interact with the robot. The participant observation method was adopted in the study. Unstructured interviews were conducted. The data divided into categories from the perspective of the Technology Acceptance Model were processed using the MAXQDA analysis tool. The density map was drawn from the “Document Portfolio.” The data were obtained as a result of participant observation. It is divided into two categories. These; are “Behavioral Responses” and “Cognitive and Emotional Responses.” The most prominent themes within the categories are video/photo taking, speaking, touching (behavioral), excitement, liking, and having fun (cognitive and emotional). The user rate of these reactions is 7/10 on average. It was observed that the participants enjoyed, were satisfied, and wanted to interact with the service robot. These findings reveal that behavioral intentions related to technology acceptance may occur against service robots.
Does Financial Stress Influence Students’ Campus Climate Perceptions and Sense of Belonging?
Authors: Zimmerman Thomas , Parker Eugene T.
Published: November 2023

Studies of financial stress, college debt, campus climate, and sense of belonging have each been conducted to better understand student retention and persistence, but few studies have explored the relationship between these variables and student outcomes. Researchers have found that financial need has a negative effect on student's psychological experiences, while other studies have explored the impact of general stress in college on psychological constructs, such as campus climate. However, little evidence exists of a relationship between financial stress, student's climate and belonging perceptions, and retention. This study investigates financial-related stressors that may impact two psychological dispositions, feelings of belonging to the institution and how they perceive the campus climate. Findings demonstrate a negative relationship between financial stress and campus climate perceptions among Students of Color, possibly explaining lower retention rates among these students.
Effects of Adjuvant Radiation Plus Chemotherapy on Survival Outcomes in Stage III C Endometrial Cancer According to Histology: Analysis of Data from the Surveillance, Epidemiology, and End Results Database
Authors: Kou Junna , Yan Guangwei , Xiao Lin , Wei Na , Ren Huayan , Xu Jingjing
Published: November 2023

Purpose: To evaluate the survival benefit of radiation plus chemotherapy in adult females with stage IIIC endometrial cancer and to investigate whether the benefit varies according to histology. Methods: Data from adult females with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC endometrial cancer, who underwent at least total hysterectomy between 2010 and 2015, were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Adjuvant treatments were categorized as chemotherapy alone, chemotherapy with external beam radiation therapy (EBRT), chemotherapy with vaginal brachytherapy (VBT), or chemotherapy with EBRT+VBT. Multivariate Cox regression models, Kaplan–Meier curves, and log-rank tests were used to assess the association between treatment modality and overall survival (OS). Results: In total, 2138 cases were identified: stage IIIC1 (n = 1299 [60.8%]) and stage IIIC2 (n = 839 [39.2%]). Median OS for all patients was 48 (interquartile range [IQR] 28-70) months. Regarding adjuvant treatment, 40.5% of patients underwent chemotherapy only, followed by chemotherapy with EBRT (35.5%). Stage IIIC patients treated with chemotherapy plus radiation exhibited a significantly reduced risk for death from endometrial cancer in both univariate and multivariate analyses ( P < 0.001). However, when stratified according to histology, OS also differed according to treatment modality when analyzing each histological type; combination therapy was no longer significantly different from chemotherapy alone for any histology (clear cell and carcinosarcoma). Combination therapy was associated with improved OS in patients with IIIC1 and IIIC2 disease. Similar associations were observed in patients with high-grade stage IIIC endometrioids. However, for low-grade tumors, combination therapy was no longer associated with reduced risk for death compared with chemotherapy alone. Conclusion: For patients with stage IIIC endometrial cancer, combined treatment with radiation and chemotherapy was associated with improved OS compared with chemotherapy alone. However, no survival benefit was found, and radiotherapy may be unnecessary in patients with low-grade endometrioids.
Call to Action: The Need for a Standardized Emotional Debriefing Model for Clinical Settings
Authors: Russell Kimberly S.
Published: November 2023

Clinicians in high-acuity hospital settings experience chronic distress due to the secondhand trauma experienced at work. Chaplains are often responsible for providing staff support to address this distress. One form of staff support is emotional debriefing after critical events. There are few publications about emotional debriefings. It would benefit chaplains to engage in research and discovery regarding emotional debriefing and create a standard model for chaplains to use in staff support.
EU legal and regulatory update September 2023
Authors: Milchior Richard
Published: November 2023

Summary of case law concerning generic medicine from the EU or EU contries.
Barriers to coach decision-making during Australian football matches and how it can be supported by artificial intelligence
Authors: Aarons Mitchell F , Vickery Will , Bruce Lyndell , Young Chris M , Dwyer Dan B
Published: November 2023

Elite sport coaches are often expected to make high-stakes decisions in time-constrained environments, such as during matches. The quality or efficiency of these decisions is bound by context-specific constraints on their decision-making. Artificial intelligence-based tools could alleviate some of these constraints. In Australian football, it is not yet known what these context-specific constraints are, nor is there any understanding of the thoughts and perception of elite Australian football coaches towards the use of artificial intelligence to support their decision-making. This study is the first to explore these issues in the context of elite Australian football and aims to inform the effective design and integration of tools to support the in-match decision-making of coaches in a manner that is welcomed by coaches. Using semi-structured interviews with elite Australian football coaches ( n = 6) and reflexive thematic analysis, two domains were explored: ‘barriers to decision-making’ and ‘thoughts and perceptions of a decision support system (DSS)’. Coaches discussed seven ‘cognitive’ and ‘environmental’ barriers, some of which may be addressed using artificial intelligence. Meanwhile, four themes were generated for the second domain, namely ‘willingness to adopt’, ‘expectation’, ‘concern and criticism’, and ‘DSS role’. The findings enable practitioners to design tools that are intended to address some of these barriers, while also providing insights into important considerations for the implementation and design of these tools that may increase the likelihood of achieving the endorsement of elite coaches and their support staff.
Efficacy of facemasks in preventing transmission of COVID-19 in non-healthcare settings: A scoping review
Authors: Enright Chloe , Gilbourne Claire , Kiersey Rachel , Parlour Randal , Flanagan Paula , McGowan Emer , Boland Mairin , Mulholland Deirdre
Published: November 2023

Background

During the COVID-19 pandemic, an abundance of literature relating to the efficacy of face masks on reducing transmission of COVID-19 in non-healthcare settings emerged.

Aim/objective

The aim of this scoping review was to allow the identification of: types of evidence conducted in this area; knowledge gaps and common concepts relating to mask efficacy in non-healthcare settings.

Methods

A comprehensive literature search was conducted in PubMed, CINAHL, MEDLINE, Embase and the Irish Management Institute bibliographic database on December 15th, 2021. All types of face masks were included. Of 722 records, 16 were included after full text screening.

Findings/results

Themes from an adapted model of Howard et al. framework were used to group results and identify common concepts. The grouped thematic results were then applied to the socio-ecological model. This illustrated the multifactorial elements determining the efficacy of masks themselves while also illustrating how other factors such as individual behaviours, social interactions, settings and national policy can influence the degree of the protective effect.

Discussion

The findings from this scoping review indicate that an abundance of experimental literature is available indicating that masks are effective at preventing COVID-19 transmission but their degree of efficacy is impacted by external factors. This review highlights that the quality of the evidence available is low.
Severe acute kidney injury in a patient with renal artery stenosis of a single-functioning kidney: A case report of rapid normalisation of the renal function after percutaneous transluminal angioplasty with stent placement
Authors: Seydoux Claire , Hemett Ould Maouloud , Périard Daniel , Descombes Eric
Published: November 2023

Revascularisation of renal arterial stenosis in acute settings, such as uncontrolled arterial hypertension, flash pulmonary oedema and/or acute renal failure, has shown controversial results in observational and prospective studies. Current guidelines do not recommend revascularisation in the occurrence of renal failure as revascularisation and best medical treatment have shown similar long-term outcomes on renal function. We describe a case of acute degradation of the renal function (with oligo-anuria and a peak creatinine of 462 µmol/L) after the re-introduction of an angiotensin-II receptor blocker (irbesartan) in a 66-year-old Caucasian diabetic male patient with bilateral renal stenosis and a right-sided single-functioning kidney, with a rapid improvement of the renal function which normalized 5 days after percutaneous angioplasty and stenting of the right renal artery.
Detecting the most critical clinical variables of COVID-19 breakthrough infection in vaccinated persons using machine learning
Authors: Daramola Olawande , Kavu Tatenda Duncan , Kotze Maritha J , Kamati Oiva , Emjedi Zaakiyah , Kabaso Boniface , Moser Thomas , Stroetmann Karl , Fwemba Isaac , Daramola Fisayo , Nyirenda Martha , van Rensburg Susan J , Nyasulu Peter S , Marnewick Jeanine L
Published: November 2023

Background

COVID-19 vaccines offer different levels of immune protection but do not provide 100% protection. Vaccinated persons with pre-existing comorbidities may be at an increased risk of SARS-CoV-2 breakthrough infection or reinfection. The aim of this study is to identify the critical variables associated with a higher probability of SARS-CoV-2 breakthrough infection using machine learning.

Methods

A dataset comprising symptoms and feedback from 257 persons, of whom 203 were vaccinated and 54 unvaccinated, was used for the investigation. Three machine learning algorithms – Deep Multilayer Perceptron (Deep MLP), XGBoost, and Logistic Regression – were trained with the original (imbalanced) dataset and the balanced dataset created by using the Random Oversampling Technique (ROT), and the Synthetic Minority Oversampling Technique (SMOTE). We compared the performance of the classification algorithms when the features highly correlated with breakthrough infection were used and when all features in the dataset were used.

Result

The results show that when highly correlated features were considered as predictors, with Random Oversampling to address data imbalance, the XGBoost classifier has the best performance (F1 = 0.96; accuracy = 0.96; AUC = 0.98; G-Mean = 0.98; MCC = 0.88). The Deep MLP had the second best performance (F1 = 0.94; accuracy = 0.94; AUC = 0.92; G-Mean = 0.70; MCC = 0.42), while Logistic Regression had less accurate performance (F1 = 0.89; accuracy = 0.88; AUC = 0.89; G-Mean = 0.89; MCC = 0.68). We also used Shapley Additive Explanations (SHAP) to investigate the interpretability of the models. We found that body temperature, total cholesterol, glucose level, blood pressure, waist circumference, body weight, body mass index (BMI), haemoglobin level, and physical activity per week are the most critical variables indicating a higher risk of breakthrough infection.

Conclusion

These results, evident from our unique data source derived from apparently healthy volunteers with cardiovascular risk factors, follow the expected pattern of positive or negative correlations previously reported in the literature. This information strengthens the body of knowledge currently applied in public health guidelines and may also be used by medical practitioners in the future to reduce the risk of SARS-CoV-2 breakthrough infection.
Novel method combining multiscale attention entropy of overnight blood oxygen level and machine learning for easy sleep apnea screening
Authors: Liang Zilu
Published: November 2023

Objective

Sleep apnea is a common sleep disorder affecting a significant portion of the population, but many apnea patients remain undiagnosed because existing clinical tests are invasive and expensive. This study aimed to develop a method for easy sleep apnea screening.

Methods

Three supervised machine learning algorithms, including logistic regression, support vector machine, and light gradient boosting machine, were applied to develop apnea screening models at two apnea–hypopnea index cutoff thresholds: [Formula: see text] 5 and [Formula: see text] 30 events/hours. The SpO2 recordings of the Sleep Heart Health Study database ( N = 5786) were used for model training, validation, and test. Multiscale entropy analysis was performed to derive a set of multiscale attention entropy features from the SpO2 recordings. Demographic features including age, sex, body mass index, and blood pressure were also used. The dependency among the multiscale attention entropy features were handled with the independent component analysis.

Results

For cutoff [Formula: see text] 5/hours, logistic regression model achieved the highest Matthew’s correlation coefficient (0.402) and area under the curve (0.747), and reasonably good sensitivity (75.38%), specificity (74.02%), and positive predictive value (92.94%). For cutoff [Formula: see text] 30/hours, support vector machine model achieved the highest Matthew’s correlation coefficient (0.545) and area under the curve (0.823), and good sensitivity (82.00%), specificity (82.69%), and negative predictive value (95.53%).

Conclusions

Our models achieved better performance than existing methods and have the potential to be integrated with home-use pulse oximeters.
The Art of Asking Good Questions in the Classroom: A Phenomenographic Study of Teacher Educators’ Recommendations
Authors: Soysal Yilmaz , Soysal Somayyeh
Published: November 2023

Purpose

This study has two objectives. The first is to describe the conceptual diversification embedded in reported documentation of teacher educators regarding the conception/phenomenon of good question-asking. Second, based on systematically observed and qualitatively analyzed diversifications, this study aims to portray the conceptual sophistication of participants’ experience-based awareness of good question-asking by constructing a hierarchical illustration.

Design/Approach/Methods

A total of 56 participants were selected based on a maximum variation strategy to capture more diversified conceptions of good question-asking. Qualitative data were collected through one-on-one phenomenographic interviews. Inductive data analysis was conducted in three phases: open coding (extracting ways of experiencing), axial coding (collapsing categories of descriptions), and diagrammatizing (establishing an outcome space).

Findings

Seven conceptual meaning clusters were gathered around four hierarchically sophisticated themes: monological (level-1 sophistication, “lowest”) (diagnostic tool), declarative (level-2 sophistication) (cognitive-emotional, pre-organizer), dialogical (level-3 sophistication) (structural qualities, typological qualities, multivocality, negotiation, internalization), and metacognitive (level-4 sophistication, “highest”) (pedagogical content knowledge of question-asking and teachers’ meta-noticing regarding question-asking).

Originality/Value

Participants’ conceptions of good question-asking showed monological and dialogical dimensions in addition to transitional (declarative) and metacognitive comprehensions. Educational recommendations are offered, especially for developing teacher educators’ question-asking noticing.
Exploring Compatibility Issues Between International Faculty and Their Host Environment: A Case of a Local National University in Japan
Authors: Kotake (小竹雅子) Masako
Published: November 2023

Purpose

The number of international faculty members in universities is increasing worldwide, and Japan is no exception. However, despite this quantitative expansion, these faculty remain peripheral. Though recent studies have identified various challenges faced by international faculty, they have focused on international faculty's individual experiences and have lacked perspectives from the host institution. To more accurately understand the challenges facing international faculty, this study aims to uncover compatibility issues between these faculty and their host environment.

Design/Approach/Methods

In this study, I adopted a qualitative case study approach targeting a local national university in Japan. Seven international and six Japanese faculty members were interviewed.

Findings

The analysis revealed various issues underlying the problems faced by international faculty, including new challenges arising from recent national university reforms. The compatibility issues they experienced can be categorized into the following six areas: organizational goals, systems and practices for hiring and evaluating faculty, division of roles between international and Japanese faculty, organizational support for international faculty, organizational culture and atmosphere, and Japanese society's overall system and values.

Originality/Value

This study responds to a crucial academic need to understand the host institution's perspective on international faculty recruitment by providing new evidence of the challenges facing international faculty and their host institution in a low-resource environment in the midst of reforms.
A Qualitative Study of Pediatric Residents’ Experiences at Morning Report
Authors: Lockwood Laura Z. , Williams Joshua T. B. , Tanverdi Melisa , Barry Seltz L.
Published: November 2023

Objectives

Morning Report is a prevalent classroom learning activity in residency programs. Yet, its contribution to resident education remains unclear. Our objective was to explore pediatric residents’ perceptions of the purpose of Morning Report as well as their experiences at Morning Report both as learners and resident presenters.

Methods

We performed a qualitative study with a grounded theory approach using semi-structured focus groups of pediatric residents (November 2016-July 2017) from a large academic health center. We analyzed data with the constant comparative method, generating codes using an iterative approach and collecting data until reaching saturation. We identified major themes and resolved disagreements by consensus.

Results

Twenty-six residents participated in five focus groups. Data analysis yielded four themes: Morning Report is Multipurpose, Socialization and Engagement Influence the Learning Environment, Potential for Emotional Discomfort, and Barriers to Prioritizing Morning Report Attendance. Residents felt the primary purpose of Morning Report was acquiring medical knowledge, but also acknowledged Morning Report's added benefits of providing an opportunity for socialization and a mental reprieve before work rounds. Residents felt Morning Report was educational when engaged in interactive discussion; however, it was challenging to meet the differing needs in this mixed learner level format. Some resident learners were hesitant to participate due to fears of being judged, and some resident presenters perceived a need to be topic experts. Clinical responsibilities and exhaustion following busy service rotations often precluded Morning Report attendance.

Conclusion

Pediatric residents described numerous purposes of Morning Report, including opportunities for valuable learning. Self-perceived learning was positively influenced by engagement and a sense of connection and challenged by emotional discomfort at times. Future work can explore how to best promote engagement and foster a safe learning environment.
Adolescents’ Experiences of Transition to Self-Management of Type 1 Diabetes: Systematic Review and Future Directions
Authors: Leocadio Paula , Kelleher Carol , Fernández Eluska , Hawkes Colin P.
Published: November 2023

Purpose:

The purpose of this systematic literature review was to explore studies that report the experiences of adolescents, their families, and health care professionals of adolescents’ transition to self-management of type 1 diabetes (T1DM).

Methods:

SocINDEX, PsycInfo, APA PsycArticles, and MEDLINE electronic databases were searched. Studies reporting on experiences of transition to self-management of T1DM for adolescents, their parents, siblings, and health care professionals published between January 2010 amd December 2021 were included. The Mixed Methods Appraisal Tool guided trustworthiness and relevance of selected studies.

Results:

A total of 29 studies met the inclusion criteria. Findings indicate that adolescents’ experiences of transitioning to self-management of T1DM are interconnected with the supports provided by others (eg, family, teachers, friends). Considering interdependence and collective lived experiences is essential to developing effective and personalized family, peer, and social interventions to facilitate transition and to avoid negative outcomes in later life. The renegotiation of roles within the network of supports that impact adolescents’ transition and adolescents’ self-negotiation have been neglected.

Conclusion:

Transition to self-management of T1DM is a dynamic and iterative process comprising of continuous shifts between interdependence and independence, making it challenging for all involved. A number of research gaps and avenues for future research are outlined.
A Soft Tissue Technique for Treating Knee Hyperextension or Recurvatum: Posterior Oblique Ligament Advancement
Authors: Franciozi Carlos E. , Mameri Enzo S. , Schumacher Felipe C. , Credidio Marcos V. , Kubota Marcelo S. , Luzo Marcus V.
Published: November 2023

Background:

Genu recurvatum is a challenging disorder and can negatively affect knee biomechanics, as reflected in its role as a risk factor for knee ligament injury and poor outcomes following ligament reconstruction or arthroplasty.

Indication:

Pathological recurvatum should be addressed in the presence of a causative correctible structural abnormality, whether due to decreased posterior tibial slope or due to multiligament injury. We described a posterior oblique ligament (POL) advancement technique for the treatment of knee recurvatum.

Technique Description:

After completion of all concomitant procedures such as ligament reconstructions, the procedure is initiated with a medial approach. The POL is isolated with an inverted L-shaped dissection and mobilized. Mattress sutures are passed through the resulting POL flap, and are re-tensioned and fixed anteriorly and distally, with the knee close to extension, in order for the imbrication to restrain hyperextension.

Results:

Anecdotal evidence points to satisfactory control of knee recurvatum postoperatively, which can potentially avoid its deleterious effects in surgical outcomes.

Discussion/Conclusion:

We present a promising option in the treatment of pathological recurvatum, with favorable cost-efficacy, low morbidity relative to slope-altering osteotomy or posterolateral soft tissue procedures, and focused on the biomechanically demonstrated main restrictors to knee hyperextension.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Reconstruction of the Anterior Cruciate Ligament and the Posterolateral Corner With a Single Combined Femoral Tunnel
Authors: Giardino Moreira da Silva Andre , Gobbi Riccardo Gomes , Bonadio Marcelo Batista , Angelini Fabio Janson , Pécora José Ricardo , Helito Camilo Partezani
Published: November 2023

Background:

Posterolateral knee injuries can occur in 16% of patients with acute ligament injuries, and up to 70% have a combined anterior cruciate ligament (ACL) tear. Studies have shown that, in different populations, the distance between the insertion of the popliteus tendon and the lateral collateral ligament (LCL) may be smaller than the 18.5 mm previously reported in the literature. When we have an associated injury of the ACL and the posterolateral corner (PLC), the confluence of tunnels in the lateral femoral condyle can be a potential problem during reconstruction surgery.

Indications:

The indication of this technique is the combined injury of the ACL and the PLC.

Technique Description:

The reconstruction is performed with 2 semitendinosus tendons and 1 gracilis tendon. The technique consists of making a tunnel in the lateral wall of the femur, from the outside-in, at the isometric point between the origin of the LCL and insertion of the popliteus tendon, and emerging in the inner wall of the lateral femoral condyle at the anatomic point of the ACL. The graft is passed from the tibia to the femur with the doubled gracilis tendon and the 2 simple semitendinosus tendons for the ACL graft. The remaining portions of the semitendinosus tendons are left for reconstruction of the PLC structures, with one of them going straight to the posterolateral tibial tunnel (reconstructing the popliteus tendon), and the other passing through the fibular head tunnel (reconstructing the LCL) and continuing from the fibular head to the posterolateral tibial tunnel (reconstructing the popliteofibular ligament).

Results:

Patients undergoing this technique achieved good functional outcomes and a failure rate similar to that reported in the literature for combined ACL and PLC reconstruction.

Discussion/Conclusion:

This technique is an excellent option for patients with the combined injury of the ACL and the PLC, avoiding the confluence of tunnels in the lateral femoral condyle. It presents good results and acceptable complication rates, compatible with the severity of this lesion.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Causes and consequences of clonal hematopoiesis
Authors: Weeks Lachelle D. , Ebert Benjamin L.
Published: November 2023

Clonal hematopoiesis (CH) is described as the outsized contribution of expanded clones of hematopoietic stem and progenitor cells (HSPCs) to blood cell production. The prevalence of CH increases dramatically with age. CH can be caused by somatic mutations in individual genes or by gains and/or losses of larger chromosomal segments. CH is a premalignant state; the somatic mutations detected in CH are the initiating mutations for hematologic malignancies, and CH is a strong predictor of the development of blood cancers. Moreover, CH is associated with nonmalignant disorders and increased overall mortality. The somatic mutations that drive clonal expansion of HSPCs can alter the function of terminally differentiated blood cells, including the release of elevated levels of inflammatory cytokines. These cytokines may then contribute to a broad range of inflammatory disorders that increase in prevalence with age. Specific somatic mutations in the peripheral blood in coordination with blood count parameters can powerfully predict the development of hematologic malignancies and overall mortality in CH. In this review, we summarize the current understanding of CH nosology and origins. We provide an overview of available tools for risk stratification and discuss management strategies for patients with CH presenting to hematology clinics.
Impact of estradiol, testosterone and their ratio on left and right auricular myofilament function in male and female patients undergoing coronary artery bypass grafting
Authors: Bening C. , Genser B. , Keller D. , Müller-Altrock S. , Radakovic D. , Penov K. , Hassan M. , Aleksic I. , Leyh R. , Madrahimov N.
Published: November 2023

Background

The impact of sex hormones on right and left auricular contractile apparatus function is largely unknown. We evaluated the impact of sex hormones on left and right heart contractility at the level of myocardial filaments harvested from left and right auricles during elective coronary artery bypass surgery.

Methods

150 patients (132 male; 18 female) were enrolled. Preoperative testosterone and estradiol levels were measured with Immunoassay. Calcium induced force measurements were performed with left- and right auricular myofilaments in a skinned fiber model. Correlation analysis was used for comparison of force values and levels of sex hormones and their ratio.

Results

Low testosterone was associated with higher top force values in right-sided myofilaments but not in left-sided myofilaments for both sexes (p = 0.000 in males, p = 0.001 in females). Low estradiol levels were associated with higher top force values in right-sided myofilaments (p 0.000) in females and only borderline significantly associated with higher top force values in males (p 0.056). In females, low estradiol levels correlated with higher top force values in left sided myofilaments (p 0.000). In males, higher Estradiol/Testosterone ratio (E/T ratio) was only associated with higher top force values from right auricular myofilaments (p 0.04) In contrast, in females higher E/T ratio was associated with lower right auricular myofilament top force values (p 0.03) and higher top force values in left-sided myofilaments (p 0.000).

Conclusions

This study shows that patients’ comorbidities influence left and right sided contractility and may blur results concerning influence of sex hormones if not eliminated. A sex hormone dependent influence is obvious with different effects on the left and right ventricle. The E/T ratio and its impact on myofilament top force showed divergent results between genders, and may partially explain gender differences in patients with cardiovascular disease.
The effect of anesthetic depth on postoperative delirium in older adults: a systematic review and meta-analysis
Authors: Wang Yafeng , Zhu Hongyu , Xu Feng , Ding Yuanyuan , Zhao Shuai , Chen Xiangdong
Published: November 2023

Background

Postoperative delirium (POD) is an important complication for older patients and recent randomised controlled trials have showed a conflicting result of the effect of deep and light anesthesia.

Methods

We included randomised controlled trials including older adults that evaluated the effect of anesthetic depth on postoperative delirium from PubMed, Embase, Web of Science and Cochrane Library. We considered deep anesthesia as observer’s assessment of the alertness/ sedation scale (OAA/S) of 0–2 or targeted bispectral (BIS) < 45 and the light anesthesia was considered OAA/S 3–5 or targeted BIS > 50. The primary outcome was incidence of POD within 7 days after surgery. And the secondary outcomes were mortality and cognitive function 3 months or more after surgery. The quality of evidence was assessed via the grading of recommendations assessment, development, and evaluation approach.

Results

We included 6 studies represented 7736 patients aged 60 years and older. We observed that the deep anesthesia would not increase incidence of POD when compared with the light anesthesia when 4 related studies were pooled (OR, 1.40; 95% CI, 0.63–3.08, P = 0.41, I2 = 82%, low certainty). And no significant was found in mortality (OR, 1.12; 95% CI, 0.93–1.35, P = 0.23, I2 = 0%, high certainty) and cognitive function (OR, 1.13; 95% CI, 0.67–1.91, P = 0.64, I2 = 13%, high certainty) 3 months or more after surgery between deep anesthesia and light anesthesia.

Conclusions

Low-quality evidence suggests that light general anesthesia was not associated with lower POD incidence than deep general anesthesia. And High-quality evidence showed that anesthetic depth did not affect the long-term mortality and cognitive function.

Systematic review registration

CRD42022300829 (PROSPERO).