bluuebunny/crossref_metadata_2025 huggingface dataset:
Leveraging Insurance Claims Data to Identify Risk Factors for Posttraumatic Osteoarthritis After Multiligament Knee Reconstruction
Authors: Jacobs Cale A. , Conley Caitlin E.W. , Johnson Darren L. , Landy David C. , Stone Austin V.
Published: April 2023

Background:

The incidence of subsequent posttraumatic osteoarthritis (OA) diagnosis after surgery and the associated risk factors have been well reported after single-ligament anterior cruciate ligament (ACL) reconstruction; however, to date, the incidence of posttraumatic OA for those who have experienced multiligament knee injury (MLKI) has been reported only in relatively small, single-center studies.

Purpose:

To compare the incidence of OA diagnoses between patients with ACL injury versus patients with MLKI and to identify risk factors for OA diagnosis after MLKI.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This study used the PearlDiver Mariner database, which contains insurance claims information on >151 million orthopaedic patients. We identified 2 cohorts for this study by using Current Procedural Terminology codes. The cohorts included patients between the ages of 16 and 60 who underwent either isolated ACL reconstruction (n = 114,282) or MLKI reconstruction (n = 3325) between July 1, 2010, and August 30, 2016. MLKI reconstruction was operationally defined as ACL reconstruction plus concurrent surgical treatment of ≥1 additional ligaments. Demographic factors, concomitant meniscal and cartilage procedures, and subsequent reoperation to restore motion were recorded, as was the incidence of knee OA diagnosis within 5 years of the index surgical procedure. OA incidence and demographic and surgical factors were compared (1) between ACL and MLKI groups and (2) between patients with MLKI either with or without OA diagnosis.

Results:

A significantly greater proportion of patients with MLKI were diagnosed with knee OA within 5 years of surgery (MLKI = 299/3325 [9.0%] vs ACL = 6955/114,282 [6.1%]; P < .0001) (odds ratio [OR], 1.52; 95% CI, 1.35-1.72; P < .001). Factors associated with increased odds of OA diagnosis after MLKI included age ≥30 years (OR, 5.90), reoperation to restore motion (OR, 2.54), obesity (OR, 1.96), mood disorder diagnoses (OR, 1.85), partial meniscectomy (OR, 1.85), and tobacco use (OR, 1.72). Concomitant meniscal repair was protective against OA diagnosis (OR, 0.06).

Conclusion:

OA incidence was greater after MLKI reconstruction than after isolated ACL reconstruction. Potentially modifiable risk factors for OA after MLKI were identified and include obesity, tobacco use, depression, and the need for motion-restoring surgery.
Childhood Residential Mobility and Mental and Physical Health in Later Life: Findings From the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Yen Irene H. , Bennett Aleena , Allen Shauntice , Vable Anusha , Long D. Leann , Brooks Marquita , Ream Robert K. , Crowe Michael , Howard Virginia J.
Published: April 2023

The study objective was to investigate the effects of childhood residential mobility on older adult physical and mental health. In REasons for Geographic and Racial Differences in Stroke (REGARDS) Study, we used linear regression models to investigate if number of moves during childhood predicted mental and physical health (SF-12 MCS, PCS), adjusting for demographic covariates, childhood socioeconomic status (SES), childhood social support, and adverse childhood experiences (ACEs). We investigated interaction by age, race, childhood SES, and ACEs. People who moved more during childhood had poorer MCS scores, β = −0.10, SE = 0.05, p = 0.03, and poorer PCS scores, β = −0.25, SE = 0.06, p < 0.0001. Effects of moves on PCS were worse for Black people compared to White people ( p = 0.06), those with low childhood SES compared to high childhood SES ( p = 0.02), and high ACEs compared to low ACEs ( p = 0.01). As family instability accompanying residential mobility, family poverty, and adversity disproportionately affect health, Black people may be especially disadvantaged.
We Usually Give Like This: Social Norms Describe Typical Charitable Causes Supported by Group Members
Authors: Chapman Cassandra M. , Dixon Lucas , Wallin Ann , Young Tarli , Masser Barbara M. , Louis Winnifred R.
Published: April 2023

Millions of nonprofits compete for a share of the billions of dollars donated to charity each year. Yet how donors select which charities to support remains relatively understudied. Social norms influence whether people give to charity at all, but no research has yet considered whether norms also communicate information about which causes group members typically support. To address this important question, we surveyed 1,735 people from 117 countries to understand whether they identified normative causes typically supported by their social groups. We found different normative giving profiles for men, women, older people, younger people, conservatives, progressives, religious, and nonreligious people, with varying degrees of consensus within each social group. Results demonstrate empirically—and for the first time—that social identities contain normative content about which charitable causes group members typically support. Some causes were relatively universally approved of or avoided. Results can inform nonprofit fundraising strategy around segmentation and targeting.
Diaspora Philanthropy in Punjab: The State, Conflicting Interests and Contested Collaborations
Authors: Varghese V. J. , Qureshi Kaveri
Published: April 2023

Taking into account the case of Indian Punjab, this paper complicates the idea of diasporic philanthropy as essentially progressive, demotic and monophonic in an attempt to underscore it as a field of diverse players, interests and signifiers. Drawing upon ethnographic observations of philanthropic networks in Punjab made by the authors between 2009 and 2017 and augmented by the analysis of policy and media reports from Punjab in the past two decades, this paper makes three interlinked arguments. First, it challenges the notion of diasporic exchanges as a one-to-one direct connection unmediated by none, by demonstrating how the state of Punjab is deeply implicated in the homeland ties of the diaspora and by formalising otherwise informal transnational philanthropic exchanges through new institutions and discourses, albeit with the often paradoxical consequence of curbing diaspora interest. Second, it argues that far from singular in their orientation towards and aspirations for the homeland, diaspora philanthropy reflects conflicting visions of development and future for home. Third, it foregrounds the waning enthusiasm of the diaspora for philanthropic investments in the face of the intractable problems of reception and questions of sustainability and the increasing involvement of local people in diaspora philanthropic endeavours, making such projects transnational collaborations for local development rather than singular diasporic initiatives of philanthropy.
Sports mega-events and cosmopolitan nationalism: A critical discourse analysis of media representations of Japan through the 2019 Rugby World Cup
Authors: Kobayashi Koji , Horne John , Lee Jung Woo
Published: April 2023

Sports mega-events, like the Rugby World Cup, are often considered as a major platform for the celebration and reinforcement of nationalism. However, there is an emerging strand of research which contends that the host nations are increasingly presenting themselves with diverse, inclusive and cosmopolitan characteristics and, in turn, forms of nationalism have undergone some noticeable changes in more recent times. In this paper, we pursue an argument that Japan as the host of the 2019 Rugby World Cup projected the nation with a cosmopolitan outlook ultimately to sustain or even strengthen national interest and identity through the process of ‘cosmopolitan nationalism’. Methodologically, the research deployed critical discourse analysis to examine media representations of Japan as the host nation in general, and its national team in particular, within one of the leading Japanese newspapers as well as a range of other publicly available resources and materials in relation to the Rugby World Cup. In result, the study reveals the ways in which the discourse of ‘One Team’, embracement of foreignness and incidents of international exchanges during the event were mobilised to generate ‘thin’ cosmopolitan moments and, at the same time, were incorporated into the narratives of Japan's success on the world stage through conditional acceptance of foreignness and diversity. Consequently, this paper offers both a theoretical underpinning for and empirical evidence of the emerging linkage between sports mega-events and cosmopolitan nationalism.
An Unusual Presentation of Metastatic BK Virus-Associated Urothelial Carcinoma Arising in the Allograft, Persisting After Transplant Nephrectomy
Authors: Jones Heather , Bhakta Anish , Jia Liwei , Wojciechowski David , Torrealba Jose
Published: April 2023

We report a 32-year-old male 14 years post-living-related kidney transplant presenting with new-onset hematuria and BK viremia. He was found to have BK virus-associated urothelial carcinoma originating in the renal allograft with locally advanced disease and metastases to multiple sites. He also developed acute T-cell-mediated rejection in the setting of immunosuppression reduction for BK viremia prior to undergoing transplant nephrectomy. Eight months following transplant nephrectomy and immunosuppression cessation, distant metastases persisted with partial response to chemotherapy and immunotherapy. Here, we discuss this unique presentation and compare it with other BK virus-associated allograft carcinomas reported in the literature, in addition to discussing evidence for the role of BK virus in oncogenesis.
Endobronchial Sialolipoma: An Uncommon Salivary Gland Tumor at an Uncommon Site
Authors: Parkhi Mayur , Mitra Suvradeep , Agarwal Ritesh , Bal Amanjit
Published: April 2023

Background

Sialolipoma is a benign neoplasm composed of neoplastic adipose tissue and normal salivary gland parenchyma. It is commonly seen in the parotid gland. The occurrence of sialolipoma in the main bronchus is exceedingly rare.

Case report

A 52-year-old diabetic and hypertensive gentleman presented with shortness of breath and cough for the last 3-4 months. Computed tomography bronchial angiography showed a soft tissue lesion in the right intermediate bronchus causing its complete obliteration and subsequent collapse of the right lower lobe. A rigid tracheobronchoscope revealed a polypoidal growth originating in the right intermediate bronchus. Histopathology revealed a sialolipoma. The patient was doing well on follow-up and no recurrence was noted to date.

Conclusion

The bronchus as the primary site for sialolipoma is unusual and has to be kept in the differential while dealing with the slow-growing endobronchial tumor.
Investigating the Latent Structure of Executive Function in the Delis–Kaplan Executive Function System Using Cattell–Horn–Carroll Theory
Authors: Furey Rachel T. , Bowden Stephen C. , Jewsbury Paul A. , Sudarshan Navaneetham J. , Connolly Madeleine L.
Published: April 2023

Objective:

To replicate a seven-factor model previously reported for the Delis–Kaplan Executive Function System (D-KEFS).

Method:

This study used the D-KEFS standardization sample including 1,750 non-clinical participants. Several seven-factor models previously reported for the D-KEFS were re-evaluated using confirmatory factor analysis (CFA). Previously published bi-factor models were also tested. These models were compared with a three-factor a priori model based on Cattell–Horn–Carroll (CHC) theory. Measurement invariance was examined across three age cohorts.

Results:

All previously reported models failed to converge when tested with CFA. None of the bi-factor models converged after large numbers of iterations, suggesting that bi-factor models are ill-suited to represent the D-KEFS scores as reported in the test manual. Although poor fit was initially observed for the three-factor CHC model, inspection of modification indices showed potential for improvement by including method effects via correlated residuals for scores derived from similar tests. The final CHC model showed good to excellent fit and strong metric measurement invariance across the three age cohorts with minor exceptions for a subset of Fluency parameters.

Conclusions:

CHC theory extends to the D-KEFS, supporting findings from previous studies that executive functions can be integrated into CHC theory.
Relational Ethics of Care in Pandemic Research: Vulnerabilities, Intimacies, and Becoming Together-Apart
Authors: Jeffrey Allison , Thorpe Holly
Published: April 2023

In this article, we draw upon the ethico-onto-epistemology of feminist new materialisms to reflect on our experiences as feminists doing research on women’s embodied experiences of sport, fitness, and well-being during the COVID-19 pandemic. For qualitative researchers around the world, COVID-19 presented a radically changed research environment. For many, the shift to doing digital interviews required the navigation of unfamiliar technologies and experimenting with different strategies for establishing connections through computer screens. As feminist scholars, working together and with the participants during times of increased stress and uncertainty prompted us to reimagine our ethical research practices. In this article, we engage and extend Rosi Braidotti’s writing on affirmative ethics and offer our personal experiences of grappling with the affective intensities of pandemic while doing ethical feminist research. Through this creative inquiry, we describe supporting one another through research and illustrate how the unique intersections of work, family, health, isolation, and exhaustion were influencing our own and participants’ lives differently. Engaging with Braidotti’s writings on affirmative ethics in the posthuman convergence, we illuminate the ways that our digital-material experiences and the human/nonhuman aspects of the research processes were re-turning our ethical considerations. Researching together, with a focus on creating space for the voices of women who have been disproportionately affected by COVID-19, we found moments of hope and joy as we creatively imagined expansive potentials for feminist research, fostered through caring collaborations.
Post-Disaster Recovery Challenges of Public Housing Residents: Lumberton, North Carolina After Hurricane Matthew
Authors: Khajehei Sayma , Hamideh Sara
Published: April 2023

The floods caused by Hurricane Matthew in 2016 affected Lumberton, a socioeconomically diverse city in North Carolina with 729 public housing units. Public housing residents face unique challenges in accessing resources and post-disaster temporary accommodations, further delaying their recovery compared to other survivors. This paper investigates the obstacles to public housing recovery and the residents’ recovery challenges using descriptive statistics, mapping, and qualitative analysis in Lumberton. Findings show the dependency of public housing units’ recovery on assistance policies and decisions of various organizations, including local housing authorities. Multiple changes in recovery plans and limited, uncertain, delayed funding and bureaucratic obstacles to funding allocation slow the units’ recovery and prolong the residents’ displacement, adversely affecting their recovery. Hence, pre-disaster resilience initiatives should address these vulnerabilities and the recovery policy's limitations to support public housing units and residents’ recovery. Moreover, affordable housing recovery must become a priority in national housing recovery policies.
Interorganizational Sensemaking of the Transition Toward a Circular Value Chain
Authors: Kuhlmann Marianne , Meuer Johannes , Bening Catharina R.
Published: April 2023

The transition toward the circular economy requires stakeholders to collaborate along value chains. Yet, such collaborations are considerably challenging. Given the paradigmatic change, stakeholders face high levels of uncertainty and also need to align on a common way forward. We extend research on interorganizational sensemaking and the circular economy by exploring the process of interorganizational alignment in a European consortium of over 150 companies representing the value chain for flexible packaging with the objective to transform the value chain from linear to circular. We find that the interorganizational sensemaking process unfolds across three levels—organization, value chain, and ecosystem—which provide different reference frames for the process. We provide insights into how these frames, power dynamics, and identity considerations influence this process. Our findings highlight the importance of considering interdependencies between stakeholders and a collective reconceptualization of the established value chain to successfully transition toward a circular one.
From Globalism to Glocalism: Consumption Patterns of Rich Kids and Its Effects on Other Young People
Authors: Afzali Rasoul , Nosrati Rouhollah , GharehBeygi Mosayeb
Published: April 2023

Consumption patterns in social groups are diversely affected by global and local processes. Using a mixed approach, this study analyses the consumption pattern of three classes of young in Tehran (capital of Iran) including the rich, middle and lower classes. The findings suggest that the self-indulgent lifestyle of rich kids of Tehran is a reproduction of global consumption patterns. The ingress of global patterns and culture into society was also mediated through the rich class, who are inclined to convergence in consumption in the global context. Rich kids act as the reference group for lifestyle among middle- and lower-class youth, who adopt eclectic lifestyles in the local context. Overall, the nature and extent to which rich kids are perceived as a reference group differ between the two classes, with the middle-class youth taking a more realistic, extensive and imitative perspective and the lower class incorporating a more mental, limited, false and damaging mindset.
Ability and Preparedness of Family Physicians to Recognise and Treat Adolescent Mental Health Disorders in Nigeria and Ghana
Authors: Oseni Tijani Idris Ahmad , Mensah-Bonsu Magdalene , Damagun Fatima Mohammed , Salam Tawakalit Olubukola , Sonny Kumbert John , Opare-Lokko Edwina Beryl Addo , Namisango Eve , Ephraim Onyenwe Chibuike
Published: April 2023

Background:

Management of mental health disorders has not been fully integrated into primary care despite been advocated by the World Health Organisation (WHO) and the World Organisation of Family Doctors (WONCA). This study therefore seeks to assess the ability and preparedness of Family Physicians to recognise and treat mental health disorders in adolescents.

Methodology:

A descriptive cross-sectional study of 233 randomly selected Physicians Practicing in Family Medicine Clinics in Nigeria and Ghana was conducted using a semi structured self-administered questionnaire that was developed by the researchers and validated with a Cronbach’s alpha coefficient of .85. Data analysis was done with the Statistical Package for Social Sciences™ (IBM Corp, Armonk, NY, USA) version 22.0.

Results:

Respondents had a mean age of 43 ± 8 years, were mostly males 130 (55.79%), practised in Nigeria 168 (72.10%) and have been in practice for over 10 years 149 (63.95%). Majority of respondents 153 (65.67%) received at least one Medical Education sessions in mental health in the preceding 12 months of the study. Out of these, 146 (95.42%) said the sessions enhanced their knowledge of mental health, and 121 (79.08%) said the sessions enhanced their abilities and preparedness to attend to patients with mental disorders. Barriers included stigmatisation 156 (66.95%), poor facilities 136 (58.37%), non-conducive environment 135 (57.94%) and non-cooperation from patients 133 (57.08%).

Conclusion:

This study showed that a lot of family physicians in Ghana and Nigeria are able and prepared to manage adolescent mental health disorders. They however cited stigmatisation, poor facilities and non-conducive environment as barriers to management of adolescent mental health disorders in primary care. Considering the severity of the disorder, there is a need to increase the training of Family Physicians in the management of adolescent mental health.
Hwang’s Philosophy for Developing an Indigenous Cultural Psychology
Authors: McWhorter Matthew R
Published: April 2023

Kwang-Kuo Hwang provides numerous recommendations for how to develop an indigenous cultural psychology. These recommendations may be understood to suggest proceeding according to three stages: (1) beginning with philosophical reflection on the meaning of modernization and exploring the topics of reality and structure (where such reflections ground one’s subsequent development of meta-models concerning self and social interaction), (2) adopting such meta-models as a hermeneutic for interpreting texts associated with one’s cultural tradition, and (3) conducting experimental studies on the basis of hypotheses derived from such cultural interpretations. Hwang’s philosophy is valuable in that it exemplifies a postmodern approach to cultural psychology that integrates traditional pre-modern forms of wisdom with modern methods of scientific investigation.
Feasibility and Efficacy of the Alert Program® for Children with Attention-Deficit/Hyperactivity Disorder
Authors: Mah Janet WT , Gill Harleen , Doherty Miranda
Published: April 2023

This study explored the feasibility and initial efficacy of a sensorimotor intervention to improve symptoms of attention-deficit/hyperactivity disorder (ADHD). Twenty-seven children (ages 8–12 years) with ADHD and their parents participated in an 8-week group intervention based on The Alert Program® for Self-Regulation (AP). Families were taught to recognize child arousal states and to use sensorimotor strategies to manage levels of alertness. Parent and teacher reports of child attention symptoms were collected at baseline, before and after intervention. Objective ratings of child problem behaviours and use of sensorimotor strategies during computerized tasks of visual and auditory attention were also coded before and after intervention. Parents and children endorsed high acceptability and satisfaction for the AP treatment. Parental ratings indicated increased knowledge and use of sensorimotor strategies, and decreased child ADHD symptoms at home from pre-AP to post-AP. However, no significant changes in child outcomes were reported by teachers. Unexpectedly, observed child problem behaviours during the visual attention task increased from pre-AP to post-AP. The AP was received positively by parents and children with improvements in regulation strategies and child attention at home, but more work needs to be done to generalize the effects to school and other peer settings.
Systematic review: Psychological/psychosocial interventions for the families of gender diverse youth under 18 years old
Authors: Lehmann Katrin , Leavey Gerard
Published: April 2023

Background

The aim of this paper is the systematic review of psychological/psychosocial interventions for gender diverse youth under 18 years of age and their families, based on the published protocol: PROSPERO 2020 CRD42020163995.

Methods

A search strategy was developed using key terms. An electronic literature search was completed using the following data bases (OVID MEDLINE; EBSCO CINAHL; ProQuest MEDLINE; OVID PsycINFO). Only studies published in English between 2001–2021 were included. This review is based on PRISMA guidance. Studies meeting inclusion criteria were quality appraised using the Mixed Methods Assessment Tool (MMAT).

Results

8405 studies were independently screened. Four studies met the inclusion criteria for the study. Parents of transgender youth attended between one and 11 psychological/psychosocial group interventions. Parents reported reduced isolation and increased knowledge, which enabled them to advocate for their young person`s needs. Psychological/psychosocial group interventions were creating challenges in terms of group processes, with some parents dominating interactions. Psychological/psychosocial group interventions were positive for parents, but no outcomes were collected for transgender young people.

Conclusion

More research is required to understand the role of group facilitators, the optimal group size and the number of psychological/psychosocial intervention sessions required.
Predicting instantaneous engine-out NOx emissions in a real-driving vehicle data scenario
Authors: Barbier Alvin , Salavert José Miguel , Palau Carlos E , Guardiola Carlos
Published: April 2023

As type approval driving cycles were found to be insufficient to represent the real impact of emissions from on-road vehicles, it became clear that real-driving emissions must be considered to effectively address the current transportation challenges. The expected introduction of on-board emission monitoring is believed to require tools that will evaluate the on-road emissions conformity of vehicles over their lifetime. In this regard, the significant amount of data made available from modern vehicles opens for improved emissions prediction and diagnostics opportunities. This article explores therefore the effectiveness of predicting instantaneous engine-out [Formula: see text] emissions given in-service vehicle data alone. To this end, a 9 months daily vehicle usage database was used to calibrate and evaluate a semi-empirical [Formula: see text] emission model and the results showed good agreement with measurements provided by the production sensor. This approach offers a tool for simulating real-driving engine-out [Formula: see text] emissions that could help to comply with emission standards by feeding and updating advanced emissions control strategies.
Visualizing loss and agency with the families of missing migrants of the Mediterranean: Design and scale in action research
Authors: Gonzalez Benson Odessa , Besprozvany Vadim , AlBader Bader , Godin Elena , Siciliano Antonio , Soltani Imed
Published: April 2023

In the migrant journey across the Mediterranean Sea, thousands have perished and many more have gone missing. Behind every missing migrant is a community awaiting closure and demanding answers. This paper draws from a US- and Tunisia-based Participatory Action Research project of visual-digital storytelling to suggest how visual and spatial questions may inform and contribute to action and social justice work, aiming to scale down the Mediterranean Sea to the personal. We highlight conceptual and procedural facets of our work, including an exhibition and an online platform, to illustrate the triple concerns of visuality, spatiality and social justice.
Reassessing Geographic, Logistical, and Cold Ischemia Cutoffs in Liver Transplantation
Authors: Ohara Stephanie , Lizaola-Mayo Blanca , Macdonough Elizabeth , Morgan Paige , Das Devika , Egbert Lena , Brooks Abigail , Mathur Amit K. , Aqel Bashar , Reddy Kunam S. , Jadlowiec Caroline C.
Published: April 2023

Introduction

Liver acceptance patterns vary significantly between transplant centers. Data pertaining to outcomes of livers declined by local and regional centers and allocated nationally remains limited.

Project aim

The objective was to compare post-liver transplant outcomes between liver allografts transplanted as a result of national and local-regional allocation.

Design

This was a retrospective evaluation of 109 nationally allocated liver allografts used for transplant by a single center. Outcomes of nationally allocated grafts were compared to standard allocation grafts (N  =  505) during the same period.

Results

Recipients of nationally allocated grafts had lower model for end stage liver disease scores (17 vs 22, P  =  .001). Nationally allocated grafts were more likely to be post-cross clamp offers (29.4% vs 13.4%, P  =  .001) and have longer cold ischemia times (median hours 7.8 vs 5.5, P  =  .001). Early allograft dysfunction was common (54.1% vs 52.5%, P  =  .75) and did not impact hospital length of stay (median 5 vs 6 days, P  =  .89). There were no differences in biliary complications ( P  =  .11). There were no differences in patient ( P  =  .88) or graft survival ( P  =  .35). In a multivariate model, after accounting for differences in cold ischemia time and posttransplant biliary complications, nationally allocated grafts were not associated with increased risk for graft loss (HR 0.9, 95% CI 0.4-1.8). Abnormal liver biopsy findings (33.0%) followed by donor donation after circulatory death status (22.9%) were the most common reasons for decline by local-regional centers.

Conclusion

Despite longer cold ischemia times, patient and graft survival outcomes remain excellent and comparable to those seen from standard allocation grafts.
Ghost Ileostomy Versus Loop Ileostomy Following Oncologic Resection for Rectal Cancer: A Systematic Review and Meta-Analysis
Authors: McKechnie Tyler , Lee Jay , Lee Yung , Tessier Léa , Amin Nalin , Doumouras Aristithes , Hong Dennis , Eskicioglu Cagla
Published: April 2023

Objective

The aim of this study was to compare ghost ileostomy (GI) and loop ileostomy (LI) in patients undergoing oncologic resection for rectal cancer in terms of postoperative morbidity.

Summary Background Data

LIs are often fashioned to protect downstream anastomoses following oncologic resection for low rectal cancer at medium-to-high risk of anastomotic leak. More recently, GIs have been utilized in patients with low-to-medium risk anastomoses to reduce the rate of unnecessary stomas.

Methods

Medline, Embase, and CENTRAL were systematically searched. Studies investigating the use of GI in patients undergoing oncologic resection for rectal cancer were included. The primary outcomes were anastomotic leak and postoperative morbidity. Secondary outcomes included stoma-related complications and length of stay (LOS). Pairwise meta-analyses were performed with inverse variance random effects.

Results

From 242 citations, 14 studies with 946 patients were included. In comparative studies, 359 patients were undergoing GI and 266 patients were undergoing LI. Pairwise meta-analysis revealed no differences in the prevalence of anastomotic leak (OR 1.40, 95%CI .73-2.68, P = .31), morbidity (OR .76, 95%CI .44-1.30, P = .32), or LOS (SMD -.05, 95%CI -.33-.23, P = .72). International Study Group of Rectal Cancer anastomotic leak grades were as follows: Grade A (GI 0% vs LI 13.3%), Grade B (GI 80.9% vs LI 86.7%), Grade C (GI 19.1% vs LI 0%).

Conclusions

GI appears to be a safe alternative to LI following oncologic resection for rectal cancer. Larger, prospective comparative studies are warranted to evaluate the use of GI in patients deemed to be at low-to-medium risk of anastomotic leak.
Leadership So White: Working Toward Equitable Representation of Latinx Leadership at Hispanic-Serving Institutions
Authors: Martinez Edna
Published: April 2023

Ximena was sure she would be appointed as the Director of Student Life at Aspirante University, a Hispanic-Serving Institution. As interim director, Ximena strove to enact servingness in her everyday practice. Her efforts to create a culturally responsive, relevant, and affirming campus environment for Latinx students were unparalleled. However, she was overlooked yet again for the directorship. This case study is intended to challenge leaders to check their assumptions and examine how they operationalize Whiteness, reproduce the dominant model of professional, and thereby preclude candidates from being earnestly and equitably considered for the job. It raises implications for current leaders who may enact deficit thinking and racially and culturally biased practices as well as for leaders who may be hindered by such practices.
NIMBUS geometric clot extractor for challenging clots: Real-world clinical experience and clot composition
Authors: Nordmeyer Hannes , Belachew Nebiyat Filate , Phung Timo Huan , Gralla Jan , Molina Gil Sara , Douglas Andrew , Neuhaus Stephanie , Haage Patrick , Doyle Karen , Mordasini Pasquale
Published: April 2023

Purpose

Revascularization rates following mechanical thrombectomy (MT) for acute ischemic stroke (AIS) remain suboptimal for patients with fibrin-rich, recalcitrant clots. The NIMBUS Geometric Clot Extractor has demonstrated promising in vitro revascularization rates using fibrin-rich clot analogs. This study assessed the retrieval rate and composition of clot using NIMBUS in a clinical setting.

Methods

This retrospective study included patients who underwent MT with NIMBUS at two high-volume stroke centers between December 2019 and May 2021. NIMBUS was used for clots deemed challenging to remove at the interventionalist's discretion. At one of the centers, per pass clot was collected for histological analysis by an independent lab.

Results

A total of 37 patients (mean age 76.87 ± 11.73 years; 18 female; mean time from stroke onset 11.70 ± 6.41 h) were included. NIMBUS was used as first and second-line device in 5 and 32 patients, respectively. The main reason for using NIMBUS (32/37) was the failure of standard MT techniques after a mean 2.86 ± 1.48 number of passes. Substantial reperfusion (mTICI ≥2b) was achieved in 29/37 patients (78.4%) with a mean of 1.81 ± 1.00 NIMBUS passes (mean 4.68 ± 1.68 passes with all devices), and NIMBUS was the final device used in 79.3% (23/29) of those cases. Clot specimens from 18 cases underwent composition analysis. Fibrin and platelets represented 31.4 ± 13.7% and 28.8 ± 18.8% of clot components; 34.4 ± 19.5% were red blood cells.

Conclusions

In this series, NIMBUS was effective in removing tough clots rich in fibrin and platelets in challenging real-world situations.
Artificial intelligence and education governance
Authors: Filgueiras Fernando
Published: April 2023

Artificial intelligence (AI) and big data methodologies have provided a vast possibility of applications in different public policy sectors. AI and big data provide essential innovations in school teaching and learning practices, curriculum, and management in education, transforming the entire formulation and implementation of education policy. The possibilities of AI in education present a high potential for improvement but a series of new risks and threats that question the benefits of adopting AI in education. This article discusses the possibilities and limits of artificial intelligence in education, observing the institutionalization of new governance practices in education that emerge with digital technologies. To discuss these new governance practices, we deal with the Beijing Consensus on artificial intelligence in education and the challenges of building new education governance. In addition, we discuss potential impacts of AI on education, with a special focus on social justice.
A response band-based method for time-dependent reliability-based robust design optimization
Authors: Lu Li , Wu Yizhong , Zhang Qi , Xia Zhehao , Qiao Ping
Published: April 2023

In this paper, a response band-based method for time-dependent reliability-based robust design optimization is proposed. The proposed method provides a novel alternative framework, consist of a two-step transformation stage and a solving stage, to solve the time-dependent reliability-based robust design optimization problem. The original time-dependent reliability-based robust design optimization problem is transformed into an equivalent deterministic robust design optimization problem in the transformation stage, and the equivalent problem is settled in the solving stage. In the transformation stage, the dynamic modal decomposition technique and the kriging technique are combined to overcome the problem that there is no standard for both time division and observation sampling in the commonly used transformation methods. In the solving stage, an approach for constructing the response band of the objective function is presented, which significantly reduces the computational consumption of the variation evaluation of the objective function. Five cases are employed to verify the effectiveness of the proposed method.
Characteristics of initiators of budesonide/glycopyrrolate/formoterol for treatment of chronic obstructive pulmonary disease (COPD) in the United States: the AURA study
Authors: Portillo Edward C. , Pollack Michael , Lee Inyoung , Sun Kainan , Zhao Xiaohui , Kruse Lisa , Feigler Norbert , Patel Sushma , Near Aimee M.
Published: April 2023

Introduction:

A twice-daily single inhaler triple therapy consisting of budesonide/glycopyrrolate/formoterol fumarate (BGF) was approved by the US Food and Drug Administration (FDA) in July 2020 as a maintenance treatment for patients with chronic obstructive pulmonary disease (COPD). The objective of this AURA study is to describe patient characteristics, exacerbation and treatment history, and healthcare resource utilization (HCRU) before BGF initiation to better inform treatment decisions for prescribers.

Methods:

This retrospective cohort study leveraged data of all payer types from IQVIA’s Longitudinal Prescription Data (LRx) linked to Medical Data (Dx). Patients with COPD who had ⩾1 LRx claim for BGF between 1 October 2020 and 30 September 2021 were included. The date of first BGF claim was the index date. Patient demographic and clinical characteristics, history of COPD exacerbation or related event, treatment history, and HCRU were assessed during the 12 months before index (baseline).

Results:

We identified 30,339 patients with COPD initiating BGF (mean age: 68.2 years; 57.1% female; 67.6% Medicare). Unspecified COPD (J44.9; 74.0%) was the most commonly coded COPD phenotype. The most prevalent respiratory conditions/symptoms were dyspnea (50.8%), lower respiratory tract infection (25.3%), and sleep apnea (19.0%). Uncomplicated hypertension (58.8%), dyslipidemia (43.9%), cardiovascular disease (41.4%), and heart failure (19.9%) were the most prevalent nonrespiratory conditions. During the 12-month baseline, 57.9% of patients had evidence of a COPD exacerbation or related event, and 14.9% had ⩾1 COPD-related emergency department (ED) visit; 21.0% of patients had evidence of prior triple therapy use, while 54.3% had ⩾1 oral corticosteroid (OCS) fill. Among OCS users, 29.9% had cumulative exposures >1000 mg [median [Q1–Q3] exposure: 520 (260–1183) mg].

Conclusion:

This real-world data analysis indicates that BGF is being initiated in patients with COPD experiencing symptoms and exacerbations despite current therapy, and among patients who have various chronic comorbidities, most often cardiopulmonary-related.
Intersection of physical and mental health of youth with brachial plexus birth injuries: A qualitative study
Authors: Purther Halle , Nitert-Brown Cora , Vahidi Ferdosi Diba , Ho Emily S
Published: April 2023

Introduction

Youth with brachial plexus birth injuries (BPBI) have an increased risk of mental health issues such as depression, anxiety, and diminished self-confidence. Despite this evidence, current standards of care focus on physical interventions. Evaluation of psychological and emotional concerns is rarely prioritized in clinical settings. Therefore, mental health needs are unmet and poorly understood.

Methods

An interpretivist qualitative approach was used to understand the perspectives of youth with BPBI and their caregivers on the barriers and facilitators of addressing mental health concerns, to inform practice guidelines, and promote meaningful participation within this population.

Results

A purposeful sample of nine youth with BPBI between 10 to 20 years and eight caregivers participated in in-depth interviews. The interviews were semi-structured and an average of 60 min (35–85 min) long. Three themes emerged from these data: (i) physical disability identity and mental health; (ii) pursuit of “normal” body image; and (iii) paradox of advocacy. Findings illuminated the intersection of physical and mental health in these youth and provides actionable practice recommendations. Areas of need were identified including mental health support around the challenges of advocacy, body image, surgery, and preparation for the ‘aging out’ process for youth and their families.

Conclusions

The well-being of youth with BPBI is a result of the intersection between their physical and mental health. Further research on optimizing mental health resources within physical health settings is needed to better support the holistic needs of these youth and their families.
The (false) promise of Germany’s Zeitenwende
Authors: Helferich John
Published: April 2023

Germany’s role as a security actor has evolved considerably over the past decades. While in the twentieth century neighbouring countries feared a resurgence of German militarism, in the twenty-first century the country has come under increasing pressure to adopt a more proactive military posture. After the Russian invasion of Ukraine shattered the European security architecture, many hoped for a groundbreaking reorientation at Europe’s economic centre. However, it is unlikely that the historic turnaround announced by Chancellor Scholz will become a reality, as the Russian war will not fundamentally change Germany’s international status, nor the key domestic factors that have historically determined its approach to security and defence policy. As Germany’s historical baggage continues to weigh heavily, it seems that reforms will not go beyond a better equipped Bundeswehr and a more power-political approach to the defence industry, which already poses a costly challenge for current and future decision-makers.
Metformin adherence and the risk of cardiovascular disease: a population-based cohort study
Authors: Yu Shun-Fan , Hong Chien-Tai , Chen Wan-Ting , Chan Lung , Chien Li-Nien
Published: April 2023

Background:

Metformin is a potent antiglycemic agent, but its importance has receded owing to the launch of novel antidiabetic medications. The benefit of metformin includes not only blood sugar control but also anti-inflammation, autophagy activation, and neuroprotection. This study investigated the risk of cardiovascular disease (CVD) in people with type II diabetes mellitus (T2DM) who adhered to metformin after adding on a second-line antiglycemic agent.

Objectives:

The purpose of this study was to investigate the benefits of metformin in CVD prevention in patients with T2DM.

Design:

We designed the study by comparing the incident rate of CVD events in patients with T2DM who received metformin continually and who ceased metformin during 2002–2014.

Methods:

Medical information was obtained from the National Health Insurance Research Database, and patients with T2DM receiving second-line antiglycemic agents were categorized into metformin-adherent and nonadherent groups according to prescription claims. The study outcomes were the incidence of CVD hospitalization, including stroke (ischemic and hemorrhagic) and myocardial infarction (MI).

Results:

A total of 31,384 patients with T2DM constituted the metformin-adherent group and were 1:1 matched to nonadherent patients. Metformin adherence was associated with a lower risk of hospitalization due to stroke [adjusted hazard ratio (aHR) = 0.51, 95% confidence interval (CI): 0.43–0.59, p < 0.001] and MI (aHR = 0.47, 95% CI: 0.43–0.53, p < 0.001). The risk reduction persisted in both ischemic and hemorrhagic strokes. Our subgroup analysis revealed that the protective effect on stroke and MI hospitalization persisted in metformin-adherent patients, both sexes, patients aged ⩽65 or >65 years, and patients with or without concurrent insulin treatment.

Conclusions:

This study revealed that metformin adherence in patients with T2DM who required a first-line treatment may reduce the risk of subsequent CVD. Despite the availability of numerous novel antiglycemic agents, metformin adherence by patients who require a combination of antiglycemic agents provides an additional benefit of CVD protection.
Effectiveness of rehabilitation strategies in primary fibromyalgia syndrome: A systematic review and meta-analysis
Authors: Pathak Akash , Rai Jyotsana , Rai Nirendra K. , Singh Ruchi , Bhatt Girish C.
Published: April 2023

Objectives

The aim of this review was to (1) summarize evidence on the effectiveness of rehabilitation strategies in fibromyalgia syndrome (FMS) and (2) determine the most effective rehabilitation strategy for reducing pain and depression in people with FMS.

Data Sources

PubMed, Ovid (Sp), and Cochrane search engines were used for identifying relevant studies done up to 1st of July 2022.

Study Selection

Randomized control trials (RCTs) that have a passive control group and an active control group were included in this review for primary and secondary aim, respectively. The primary outcome measures were pain and depression. Secondary outcome was one from the sleep or fatigue or healthy related quality of life (HRQOL).

Data Extraction

Two researchers independently selected the studies and extracted the key information.

Data Synthesis

A total of 25 RCTs were included. Studies with passive control group showed moderate to large positive effects on pain (standard mean difference –0.65, 95% confidence interval −0.93 to −0.38; I2 = 72%) and HRQOL (MD −5.40, 95% CI −10.17 to −0.62; I2 = 74%) but were not statistically significant for sleep, fatigue, and depression. Furthermore, on subgroup analysis studies with a short term protocol showed significant effects on pain only, whereas studies with long term protocols showed positive effects on pain and HRQOL only, but no statistical significance at the time of post-trial follow-up. Studies with active control groups gave non-significant results except where there was mixed exercises, which showed a positive effect (mean difference −4.78, 95% CI −7.98 to −1.57; I2 = 0%) for HRQOL.

Conclusion

All rehabilitation strategies were effective for pain and HRQOL, and had a marginal effect on depression, sleep, and fatigue but efficacy was not maintained at the time of post-trial follow-up. However, in this review, we could not differentiate any rehabilitation strategies for the best among those used in the included studies.