bluuebunny/crossref_metadata_2025 huggingface dataset:
Myricetin (3,3′,4′,5,5′,7-hexahydroxyflavone) prevents ethanol-induced biochemical and inflammatory damage in the liver of Wistar rats
Authors: Ahmad Sheikh Bilal , Rashid Shahzada Mudaisr , Wali Adil Farooq , Ali Shafat , Rehman Muneeb U , Maqbool Mir Tahir , Nadeem Ahmed , Ahmad Sheikh Fayaz , Siddiqui Nahid
Published: February 2022

Purpose: The current investigation was carried out to evaluate the efficacy of myricetin in ethanol-induced liver toxicity in Wistar rats. 

Research Design: Twenty-four rats were randomly divided into four groups with six animals per group. Group-I animals were administered with vehicle (distilled water), Group II, III, and IV were treated orally with sequential (per week) increase in the dose of ethanol (5, 8, 10, and 12 g/kg b wt per week in each group) for 28 days. Myricetin was treated orally to Group-III and IV animals at the respective doses of 25 mg/kg b wt. and 50 mg/kg b wt. 

Results: Our results showed that myricetin prevented hepatotoxicity by modulating the production of free radicals, ethanol metabolizing enzymes, and inflammatory markers in vivo. Myricetin also helped maintain lipid membrane integrity, oxidant-antioxidant status, and histoarchitecture. Ethanol administration caused elevation in XO, ADH, and CYP2E1 in hepatic tissue, which significantly normalized with myricetin administration. After ethanol administration, there was a steep increase in the hepatotoxicity biomarkers, including ALT, MDA, and AST. The level of cytotoxicity marker LDH also increased after ethanol administration; myricetin administration decreased the level of all these markers. Moreover, myricetin treatment also reduced ethanol-induced inflammatory markers such as NF-κB and IL-6. 

Conclusion: Findings from the current study demonstrate that myricetin administration prevents alcohol-induced hepatic injury by influencing the metabolism of ethanol, inhibiting oxidative stress, maintaining lipid profile, and suppressing inflammatory markers.
Ten Lessons About Infants’ Everyday Experiences
Authors: de Barbaro Kaya , Fausey Caitlin M.
Published: February 2022

Audio recorders, accelerometers, and cameras that infants wear throughout their everyday lives capture the experiences that are available to shape development. Using sensors to capture behaviors in natural settings can reveal patterns within the everyday hubbub that are unknowable using methods that capture shorter, more isolated, or more planned slices of behavior. Here, we review 10 lessons learned from recent endeavors in which researchers neither designed nor participated in infants’ experiences and instead quantified patterns that arose within infants’ own spontaneously arising everyday experiences. The striking heterogeneity of experiences—the fact that there is no meaningfully “representative” hour of a day, instance of a category, interaction context, or infant—inspires next steps in theory and practice that embrace the complex, dynamic, and multiple pathways of human development.
Exploring the Impact of Entrepreneurial Skills on the Performance of Uttarakhand Based Start-ups
Authors: Bahuguna Pinky , Dangwal R. C.
Published: February 2022

Entrepreneurship innovation is found many times in the literature, but empirical research on the growth and development of start-ups is underdeveloped. Many studies have pointed out that the rate of the launch of start-ups being high and start-ups not able to survive is highly correlated. This article is a modest attempt to bridge this gap by identifying the entrepreneurial factors affecting the performance of early-stage start-ups based in Uttarakhand. This is an exploratory study based on the primary data collected from a sample of 147 start-up founders. A self-administered questionnaire, including 18 Likert items for three independent variables was used and pilot-tested which subsequently came down to thirteen after deleting five items. A random sampling technique was applied to choose respondents from the Dehradun and Haridwar districts of Uttarakhand state. The data were analysed using descriptive statistics, exploratory factor analysis, Cronbach’s alpha, with the help of SPSS software (version 23). Multiple regression analysis was used to analyse the impact of three extracted factors on the performance of start-ups. The study has revealed that the leadership skills, technical skills and marketing skills of entrepreneurs significantly contribute to the performance of start-ups in Uttarakhand state.
Chinese School Principals Explore the Fifth Discipline Fostering a Learning Community in a High School in Beijing
Authors: Zhang Wei
Published: February 2022

This qualitative case study explores the Chinese school principals’ experiences in building a learning community through the Fifth Discipline (shared vision, personal mastery, mental models, team learning, and system thinking) in helping them embrace student engagement, teacher commitment, and parents’ involvement for school improvement and student achievement. Findings show that principals face three challenges, including (1) testing score limits to create a learning community; (2) saving cost causes difficulty to hire a highly professional teacher; (3) high expectations cause the high rate of dropout. This study also finds three ways in using the Fifth Discipline for student engagement, teacher commitment, and parent involvement which are (1) communication, (2) self-improvement, and (3) self-reflection. Findings show that principals use three strategies of nurturing school capacity, including (1) visibility, (2) educational core values, and (3) lifelong learning. The future qualitative grounded theory research design of using the Fifth Discipline was suggested by interviewing principals, teachers, parents, and students to create a leadership framework in leading the school change in the 21st century.
Missed Opportunities? An Observational Analysis of Lung Cancer Screening Utilization Amongst Patients With Lung Cancer
Authors: Olazagasti Coral , Ehrlich Matthew , Kohn Nina , Aviles Karen , Hoilett Aldane , Seetharamu Nagashree
Published: February 2022

Lung cancer (LC) is the leading cause of cancer-related deaths worldwide. The U.S. Preventive Services Task Force (USPSTF) and National Comprehensive Cancer Network (NCCN) recommend annual low-dose CT chest (LDCT) for LC screening in high-risk adults who meet appropriate criteria, which primarily focus on age and smoking history. Despite this, screening rates remain low and patients with LC are typically diagnosed at a later stage.

We conducted a single-center retrospective analysis of patients with an established diagnosis of lung cancer to evaluate if screening guidelines were appropriately followed before the cancer diagnosis.

Patients diagnosed with LC between 2016 and 2019 were included in the analysis. Charts were reviewed for demographics, detailed smoking history, as well as histology and stage of LC. Associations between categorical factors and screening were examined using the chi-square test. Associations between continuous and ordinal factors and screening were examined using the Mann–Whitney test.

A total of 530 charts were reviewed, of which 52% met NCCN criteria and 35% met USPSTF criteria. Only 4.0% and 4.8% of patients who met NCCN and USPSTF criteria, respectively, underwent screening. There was a significant association between staging at diagnosis and screening with LDCT. All the patients who had screening CT scans were diagnosed at localized stages of lung cancer in both NCCN and USPSTF groups compared to 49.1% and 48% in eligible subjects that did not undergo screening, respectively.

Our study showed that despite established guidelines for LC screening and insurance coverage, a vast majority of screening-eligible LC patients have never had LDCT. We found that patients who underwent screening as per guidelines were diagnosed at earlier stages of the disease. Ongoing efforts to increase awareness and adherence to LC screening guidelines are needed to improve early detection and reduce LC mortality.
Platelet Dysfunction in Cardiac Surgery: When is the Best Time to Assess It? An Observational Single Center Study
Authors: Auci Elisabetta , Vendramin Igor , Barbariol Federico , Riccardi Ilaria , Gigante Andrea , Baroselli Antonio , Bove Tiziana , Bassi Flavio , Vetrugno Luigi , Livi Ugolino
Published: February 2022

Purpose. Cardiac surgery is characterized by a high risk of complications related to perioperative bleeding. Guidelines suggest the use of local algorithms based on perioperative point-of-care tests to assess and manage potential coagulation abnormalities. We investigated whether heparin reversal administration affects the adenosine-5-diphosphate (ADP) test values, thus identifying the earliest time point following cardio-pulmonary bypass that permits the promptest detection and treatment of potential platelet dysfunctions. Methods. This was a retrospective, single-center, observational study enrolling cardiac surgery patients requiring cardiac bypass. ADP-tests at 4 different time-points during surgery (T0: baseline, T1: at aortic de-clamping, T2: 10 minutes after protamine administration, and T3: at the end of surgery) were performed. Results. 63 patients undergoing elective cardiac surgery were studied. Baseline ADP-test values were almost constantly greater than intraoperative values, and end of surgery values were often greater than previous intraoperative values. The only difference that proved to be not statistically significant was between T1 and T2, with a clinically insignificant mean difference of −.2 U (95%CI of difference: −6.9 - 6.5 U). There was no correlation between the variation in ADP-test values pre- and post-protamine administration and the protamine-to-heparin ratio. Conclusion. The results of the present study support the hypothesis that the ADP-test could be performed early, at aortic de-clamping before protamine administration. This approach allows for the promptest assessment of a potential impairment in platelet function, and its timely correction.
Characteristics of invention development during the hackathon
Authors: Rys Maciej
Published: February 2022

The hackathon was developed by practitioners and it could be said that they used structures and characteristics from other invention development methods that intend to spark creativity. This paper aims to define and evaluate those characteristics that serve as determinants of invention. It analyses research performed on 14 different hackathons with the following ethnographic approach: 1000 h of observation, 36 semi-structured interviews and digital ethnography (netnography). Collected data has been analysed with the use of grounded theory methods and machine learning, which has been introduced as a triangulation method. As a result 9 main characteristics within the hackathon method that serve as invention determinants were discovered and holistically described. The identified elements have been backed by different theoretical backgrounds, but as one they form a flexible and unique mixture that helps to understand the hackathon phenomenon, potential hazards and its inner mechanisms. The discovered characteristics can help in effective organization of hackathons in the future.
Ambiguous interventions: The social consequences of assistance in the field
Authors: Reed Amber R. , Golomski Casey
Published: February 2022

This article examines how race, gender, and generation influence ethnographers’ ethical decision-making in the field. We consider how decisions to intervene engage these complex variables, which are both cultural and historical constructs as well as lived experiences that researchers and interlocutors differently embody over time. We discuss this from the vantage point of postcolonial communities in South Africa’s Eastern Cape and eSwatini, where we have done fieldwork for over a decade. Our examples highlight researchers’ involvement in crises surrounding rites of passage. When rites went wrong, conflicting forces of race, gender, and generation both confounded our interlocutors’ abilities to define who they might become as well as challenged our own efforts to support them in social and material ways. We argue that “interventions” in fieldwork are intrinsically multidirectional and ethically ambiguous; this ambiguity is an epistemic and practical force that ethnographers must make explicit to realize potentialities for “otherwise” worlds.
Appreciating situations of breakdown for researcher reflexivity
Authors: Treacy Danielle
Published: February 2022

Responding to the identified need for reflection, critique, and evaluations of appreciative inquiry (AI), a form of action research, this article presents a critical reflection on an application of AI in a cross-cultural music education research project. AI was selected as it appeared to both have potential for addressing the complexities related to power imbalances, ethnocentrism, and coloniality inherent in a project aiming to co-develop music teacher education in Finland and Nepal, and because its 4D model supported the co-constructing of visions, which was central to the project. The critical reflection presented in this article focused on three situations of breakdown that occurred during the research process. Analysis of these breakdowns highlighted the need for researchers to engage responsibly in research as participants, account for dreaming as an unevenly distributed capacity when working with visions or aspirations, and develop skills facilitating collaborative spaces that cultivate listening for and appreciating difference. The article concludes by recognising the limitations of undertaking this reflection independently rather than collaboratively and by cautioning against the instrumentalization of appreciation, calling instead for sincere appreciation. Overall, the article contends that the process of identifying and generating new understandings of breakdowns is a powerful approach for stimulating researcher reflexivity.
Proximal Interphalangeal Joint Congruity: A Biomechanical Study
Authors: Levy Kenneth H. , Kurtzman Joey S. , Horowitz Evan H. , Dar Qurratul-Ain , Hayes Westley T. , Koehler Steven M.
Published: February 2022

Background:

Surgical approaches to the proximal interphalangeal (PIP) joint often require disruption of soft tissue stabilizers. Additionally, PIP joint injuries frequently result in soft tissue disruption. This study evaluates the necessity of repairing soft tissue stabilizers by assessing their role in maintaining native joint congruity.

Methods:

Eight specimens were used to evaluate congruity at 0° and 30° flexion when loaded with 2 N of valgus force. This was performed in the native joint and after sequential sectioning of the surrounding ligaments in order: volar plate (VP), radial collateral ligament (CL), and ulnar CL. The skin flap was sutured with the ligaments unrepaired and the load was reapplied. Radiographs were taken after each load and used to measure the joint line convergence angle (JLCA).

Results:

Mean JLCA increased in both degrees of flexion after ligaments were sectioned but was only significantly different from the native joint after the VP was disrupted along with 1 CL. Joint congruity improved following repair of the skin flap in both degrees of flexion but was not significant. Joints were more congruent in 30° flexion for all subgroups, but none were significantly different compared to 0° flexion.

Conclusions:

Disruption of the VP is insufficient to significantly alter PIP joint congruity. While sectioning of both the VP and CLs resulted in a statistically significant change in joint congruity, mean JLCA demonstrated changes of minor clinical significance. The osseous anatomy of the phalanges imparts inherent stability that maintains a congruent joint despite loss of the soft tissue stabilizers.
Telemonitoring and Case Management for Hypertensive and Remote-Dwelling Patients With Chronic Kidney Disease—The Telemonitoring for Improved Kidney Outcomes Study (TIKO): A Clinical Research Protocol
Authors: Okpechi Ikechi G. , Zaidi Deenaz , Ye Feng , Fradette Miriam , Schick-Makaroff Kara , Berendonk Charlotte , Abdulrahman Abdullah , Braam Branko , Ghimire Anukul , Hariramani Vinash Kumar , Jindal Kailash , Khan Maryam , Klarenbach Scott , Muneer Shezel , Ringrose Jennifer , Scott-Douglas Nairne , Shojai Soroush , Slabu Dan , Sultana Naima , Tinwala Mohammed M. , Thompson Stephanie , Padwal Raj , Bello Aminu K.
Published: February 2022

Background:

Hypertension, together with poorly controlled blood pressure (BP) are known risk factors for kidney disease and progression to kidney failure as well as increased cardiovascular (CV) morbidity and mortality. Several studies in patients without kidney disease have demonstrated the efficacy of home BP telemonitoring (HBPT) for BP control.

Objective:

The primary aim of this study is to assess the mean difference in systolic BP (SBP) at 12 months, from baseline in remote dwelling patients with hypertension and chronic kidney disease (CKD) in Northern Alberta, Canada, comparing HBPT + usual care versus HBPT + a case manager. Other secondary objectives, including cost-effectiveness and acceptability of HBPT as well as occurrence of adverse events will also be assessed.

Methods

Design:

This study is designed as a pragmatic randomized controlled trial (RCT) of HBPT plus clinical case management compared to HBPT with usual care.

Setting:

Peace River region in Northern Alberta Region, Canada.

Patients:

Primary care patients with CKD and hypertension.

Measurements:

Eligible patients will be randomized 1:1 to HBPT + BP case management versus HBPT + usual care. In the intervention arm, BP will be measured 4 times daily for 1 week, with medications titrated up or down by the study case manager until guideline targets (systolic BP [SBP]: <130 mmHg) are achieved. Once BP is controlled, (ie, to guideline-concordant targets), this 1-week protocol will be repeated every 3 months for 1 year. Patients in the control arm will also follow the same BP measurement protocol; however, there will be no interactions with the case manager; they will share their BP readings with their primary care physicians or nurse practitioners at scheduled visits.

Limitations:

Potential limitations of this study include the relatively short duration of follow-up, possible technological pitfalls, and need for patients to own a smartphone and have access to the internet to participate.

Conclusions:

As this study will focus on a high-risk population that has been characterized by a large care gap, it will generate important evidence that would allow targeted and effective population-level strategies to be implemented to improve health outcomes for high-risk hypertensive CKD patients in Canada’s remote communities.

Trial Registration:

www.clinicaltrials.gov (NCT number: NCT04098354)
Initial Validation of the ASCA-Informed Student Needs Assessment—High School Version
Authors: Boulden Rawn A.
Published: February 2022

This study aimed to develop and validate the ASCA-Informed Student Needs Assessment—High School Version, an ASCA-informed and practitioner-friendly instrument that high school counselors can administer to students to identify pressing student needs. The results revealed a four-factor model consisting of the following dimensions: (a) school connectedness and prosocial skills, (b) social/emotional support, (c) academic and career development, and (d) relationships and emotional regulation. The study’s findings suggest suitable reliability and validity. This article discusses implications and areas for future research.
Ginseng for the Treatment of Chronic Fatigue Syndrome: A Systematic Review of Clinical Studies
Authors: Yang Juan , Shin Kyung-Min , Abu Dabrh Abd Moain , Bierle Dennis M , Zhou Xuan , Bauer Brent A. , Mohabbat Arya B
Published: February 2022

Background

Chronic fatigue syndrome (CFS) is a complex and often disabling chronic condition emerging worldwide, with no curative or definitive therapy yet identified. Ginseng has been widely used to treat fatigue in other patient groups and conditions; however, a systematic review focusing solely on the impact of ginseng on fatigue in patients with CFS has not been performed.

Objective

This study aimed to assess the current state of evidence regarding ginseng for CFS.

Methods

Multiple databases were searched from inception to October 2020. All data was extracted independently and in duplicates. Outcomes of interest included the effectiveness and safety of ginseng in patients with CFS.

Results

2 studies enrolling 68 patients were deemed eligible, including one randomized clinical trial and one prospective observational study. The certainty of evidence in the effectiveness outcome was low and moderate from both studies, while the safety evidence was very low as reported from one study.

Conclusion

Study findings highlight a potential benefit of ginseng therapy in the treatment of CFS. However, we are not able to draw firm conclusions due to limited clinical studies. The paucity of data warrants limited confidence. There is a need for future rigorous studies to provide further evidence.
Cardiovascular Disease Risk Factors in Hypertensive Patients: A Case Study of Jimma University Medical Center
Authors: Ayele Habtamu , Banbeta Akalu , Negash Abiyot
Published: February 2022

Background

Cardiovascular diseases are a group of disorders of the heart and blood vessels. Globally an estimated 17.9 million people died from cardiovascular diseases, which covers 31% of all global deaths, and the three quarters taking place in developing countries. Hypertension is the major cause of cardiovascular diseases. Its influence is high with other risk factors. This study aimed to determine the major risk factors of cardiovascular disease among hypertensive patients at Jimma University Medical Center.

Methods

Using December to January 2017 hypertension-related report of Jimma University Medical Center (JUMC), a retrospective cohort study type was conducted on purposively selected 343 patients. Three nurses from JUMC participated in the data collection, and the data were fitted using the Cox-Proportional Hazard (Cox-PH) model.

Results

About 138 (40.23%) patients were experienced cardiovascular disease at 28 months median time. From the Cox-PH model, the hazard ratio and 95% CI of age (HR = 1.0495, 95% CI: 1.0250-1.0747), urban (HR = 2.1225, 95% CI: 1.3813-3.2613), diabetes mellitus (HR = 1.702, 95% CI: 1.0082-2.8731), proteinuria (HR = 1.8749, 95% CI: 1.2675-2.7734), two drug users (HR = 0.2533, 95% CI: 0.1376-0.4662), systolic blood pressure (HR = 1.0343, 95% CI: 1.0147-1.0542) and pulse rate (HR = 1.0111, 95% CI: 0.9933-1.0293).

Conclusion

The presence of proteinuria, diabetes mellitus, and being an urban resident had a great impact on the cardiovascular diseases of hypertensive patients.
Caste Environment and the ‘Unthinkability’ of ‘Annihilation of Caste’
Authors: Roy Ishita
Published: February 2022

This article revisits Ambedkar’s speech ‘Annihilation of Caste’, the delivery of which was stalled as permission for it was withheld by the organization who had originally invited Ambedkar to deliver a talk on curbing denigrating social practices like ‘untouchability’. The article revisits this moment of denial as well as the speech in its written form and argues for the political significance both (the ‘speech’ and the ‘final act of denial’) hold in contemporary Indian socio-political culture with respect to caste and its ideological mechanisms. It is argued that the consequent ‘final un-deliverance of the speech’, owing to its cancellation by the Mandal, the conference organizer, accounts for political Hinduism’s ‘unthinkability’ to accept any intellectual that does not belong to the ‘upper’ caste/caste dominant to exegete on any matter requiring intellectual exercise. This article attempts a critique of this ‘unthinkability’, which it argues is a basic paradigm in the ideology of caste.
A Review of the Perspectives of Social Justice with Special Reference to the Ambedkarism
Authors: Hantal Bhimasen
Published: February 2022

Social justice is a very old concept, which germinated in its mature forms during the era of Gautam Buddha, Plato and Aristotle, and has undergone continual academic and sociopolitical refinements over the centuries through rich contributions of many Kings, Queens, Social Workers, Scholars and others. The concept social justice has always been placed at prominent places by the academic community whether discussing of the colonialism, globalism, communism or other issues. Karl Marx reignited the notion of social justice among the intellectuals. After WWII, most of the nations gained independence, and thus the significance of the social justice increased manifold than ever before—to see that how far these countries deliver justice to the marginalized communities at their territories, since they are no more under the clutch of their erstwhile colonial masters. Thus, during the entire period starting from Plato to Rawls and beyond many scholars have contributed through various perspectives on the issue of justice. The major theories have been grouped here into various perspectives and briefly reviewed, with an emphasis on the previously somewhat neglected Ambedkarism, as the author found that this ideology to be even more relevant and practical in the modern context of globalization.
‘An Alternate Conclusion of Misadventure’: Construction of the Female Body in Rape Trial
Authors: Joshi Jayat
Published: February 2022

I aim to examine the discursive construction of the female body and the definitions of rape and consent in the language used in the Indian courtroom. In order to do so, I locate my analysis in two recent controversial judgements— Mahmood Farooqui v. State (Govt. of NCT of Delhi), 2017 and Vikas Garg and others v. State of Haryana, 2017—both of which reveal how judicial discourse produces female (and male) bodies as normalized sites of a distorted sexuality. Further analysis shows the limitations of legal grammar and semantics in envisaging the female body outside of categories existing in relation to men, and the failure of the judicial apparatus when such classifications crumble. To develop this analysis, I chiefly draw upon the writings of scholars of legal feminism and a scrutiny of reports of the Law Commission of India. The purpose of this article is therefore to arrive at an understanding of the subject of the law as not merely a theoretical, objective entity but as a product of a gendered, variable ideological context, thereby exposing the weaknesses of the linguistic construction of the female body and how it affects decisions of the courts.
An exploratory study protocol examining if assertive integrated service delivery better meets the psychosocial and mental health needs of young people in out of home care
Authors: Foord Rachael , Drever Saskia , Mendoza Diaz Antonio , Hobby Lucy , Medel Natalie , Burman Charlotte , Eapen Valsamma , Jairam Rajeev
Published: February 2022

Young people in Out of Home Care (OoHC) have complex mental health and psychosocial needs due to a range of individual, systemic and intergenerational factors that may limit the effectiveness of usual clinic-based services. To address this, in 2017 an assertive-integrated service (AIS) model of care was adopted by the Child and Adolescent Mental Health Service (CAMHS) in South Western Sydney Local Health District (SWSLHD), Australia, through outreach to the young person in the community. This paper outlines the study protocol comparing AIS with clinic-based CAMHS usual care to meet the physical, mental health and wellbeing needs of young people in OoHC. Using routinely collected outcome data, the AIS model will be compared to clinic-based CAMHS treatment as usual care. Measures of overall functioning (e.g. Global Assessment Scale [CGAS]), psychological functioning (e.g. Strength and Difficulties Questionnaire [SDQ]), general health and social functioning (e.g. Health of the Nation Outcome Scales for Children and Adolescents [HoNOSCA]) and other relevant socio-demographic and clinical variables will be collected at intake and at 3-month intervals until discharge from the respective services. Semi-structured interviews will also be conducted with young people, their carers, and service providers, to examine qualitative themes about the suitability of service provision. It is expected that a better understanding of the key indicators of functioning for young people accessing AIS and clinic-based services will help inform what works for these young people so that they can receive targeted and tailored support from the start of service engagement.
How does subnational variation in repression affect attitudes toward police? Evidence from Iraq’s 2019 protests
Authors: Revkin Mara R.
Published: February 2022

Recent episodes of severe police repression and violence against protesters around the world have brought new urgency to longstanding calls for police reform and in some cases more fundamental structural changes including abolition of existing police institutions. However, the police are not monolithic and there is considerable subnational variation in the extent to which individual police officers and units use excessive force against civilians, and this variation has important implications for police legitimacy in the eyes of the public. In Iraq, where federal police violently repressed anti-government demonstrations in 2019—killing more than 600 protesters—but local police refrained from violence and in some cases intervened to protect civilians, public opinion became significantly more negative toward federal police but not toward local police. These results suggest that civilians distinguish between the conduct of different actors in a decentralized, fragmented security apparatus and attribute blame individually rather than collectively blaming the state security apparatus as a whole. I suggest that two mechanisms—decentralization and fragmentation of state security institutions—interact to shape the pattern of subnational police violence in Iraq and discuss broader implications for police reform in Iraq and beyond.
Characteristics and outcomes of patients undergoing anesthesia while SARS-CoV-2 infected or suspected: a multicenter register of consecutive patients
Authors: James Arthur , De Jong Audrey , Jeanmougin Thomas , Blanie Antonia , Figueiredo Samy , Goffin Pierre , Le Guen Morgan , Kantor Elie , Cipriani Flora , Campion Sébastien , Raux Mathieu , Jaber Samir , Futier Emmanuel , Constantin Jean-Michel ,   For the Société Française d’Anesthésie Réanimation (SFAR) Research Network, De Rocquigny Gael , Le Gouez Agnes , Lefrançois Valentin , Zioui Safia , Greze Jules , Pagoni Eleni , Puel Floriane , Buisset Carole , Cinotti Raphael , Péricard Christophe , Lemoine Adrien , Soubirou Jean Luc , Fontaine Mathieu
Published: February 2022

Background

There are limited data to detail the perioperative anesthetic management and the incidence of postoperative respiratory complications among patients requiring an anesthetic procedure while being SARS-CoV-2 positive or suspected.

Methods

An observational multicenter cohort study was performed including consecutive patients who were SARS-CoV-2 confirmed or suspected and who underwent scheduled and emergency anesthesia between March 17 and May 26, 2020.

Results

A total of 187 patients underwent anesthesia with SARS-CoV-2 confirmed or suspected, with ultimately 135 (72.2%) patients positive and 52 (27.8%) negative. The median SOFA score was 2 [0; 5], and the median ARISCAT score was 49 [36; 67]. The major respiratory complications rate was 48.7% (n = 91) with 40.4% (n = 21) and 51.9% (n = 70) in the SARS-CoV-2–negative and –positive groups, respectively (p = 0.21). Among both positive and negative groups, patients with a high ARISCAT risk score (> 44) had a higher risk of presenting major respiratory complications (p < 0.01 and p = 0.1, respectively).

Discussion

When comparing SARS-COV-2–positive and –negative patients, no significant difference was found regarding the rate of postoperative complications, while baseline characteristics strongly impact these outcomes. This finding suggests that patients should be scheduled for anesthetic procedures based on their overall risk of postoperative complication, and not just based on their SARS-CoV-2 status.
Development and validation of a model to predict rebleeding within three days after endoscopic hemostasis for high-risk peptic ulcer bleeding
Authors: Lai Yongkang , Xu Yuling , Zhu Zhenhua , Pan Xiaolin , Long Shunhua , Liao Wangdi , Li Bimin , Zhu Yin , Chen Youxiang , Shu Xu
Published: February 2022

Background

Peptic ulcer bleeding remains a typical medical emergency with significant morbidity and mortality. Peptic ulcer rebleeding often occurs within three days after emergent endoscopic hemostasis. Our study aims to develop a nomogram to predict rebleeding within three days after emergent endoscopic hemostasis for high-risk peptic ulcer bleeding.

Methods

We retrospectively reviewed the data of 386 patients with bleeding ulcers and high-risk stigmata who underwent emergent endoscopic hemostasis between March 2014 and October 2018. The least absolute shrinkage and selection operator method was used to identify predictors. The model was displayed as a nomogram. Internal validation was carried out using bootstrapping. The model was evaluated using the calibration plot, decision-curve analyses, and clinical impact curve.

Results

Overall, 386 patients meeting the inclusion criteria were enrolled, with 48 patients developed rebleeding within three days after initial endoscopic hemostasis. Predictors contained in the nomogram included albumin, prothrombin time, shock, haematemesis/melena and Forrest classification. The model showed good discrimination and good calibration with a C-index of 0.854 (C-index: 0.830 via bootstrapping validation). Decision-curve analyses and clinical impact curve also demonstrated that it was clinically valuable.

Conclusion

This study presents a nomogram that incorporates clinical, laboratory, and endoscopic features, effectively predicting rebleeding within three days after emergent endoscopic hemostasis and identifying high-risk rebleeding patients with peptic ulcer bleeding.

Trial registration This clinical trial has been registered in the ClinicalTrials.gov (ID: NCT04895904) approved by the International Committee of Medical Journal Editors (ICMJE).
Cervical cancer screening coverage and its related knowledge in southern Malawi
Authors: Gerstl Sibylle , Lee Lawrence , Nesbitt Robin C. , Mambula Christopher , Sugianto Hartini , Phiri Twambilire , Kachingwe James , Llosa Augusto Eduardo
Published: February 2022

Background

Cervical cancer (CC) is the fourth most common cancer among women worldwide and Malawi has the world’s highest rate of cervical cancer related mortality. Since 2016 the National CC Control Strategy has set a screening coverage target at 80% of 25-49-year-old women. The Ministry of Health and Médecins Sans Frontières (MSF) set up a CC program in Blantyre City, as a model for urban areas, and Chiradzulu District, as a model for rural areas. This population-based survey aimed to estimate CC screening coverage and to understand why women were or were not screened.

Methods

A population-based survey was conducted in 2019. All resident consenting eligible women aged 25-49 years were interviewed (n = 1850) at households selected by two-stage cluster sampling. Screening and treatment coverage and facilitators and barriers to screening were calculated stratified by age, weighted for survey design. Chi square and design-based F tests were used to assess relationship between participant characteristics and screening status.

Results

The percentage of women ever screened for CC was highest in Blantyre at 40.2% (95% CI 35.1-45.5), 38.9% (95% CI 32.8-45.4) in Chiradzulu with supported CC screening services, and lowest in Chiradzulu without supported CC screening services at 25.4% (95% CI 19.9-31.8). Among 623 women screened, 49.9% (95% CI 44.0-55.7) reported that recommendation in the health facility was the main reason they were screened and 98.5% (95% CI 96.3-99.4) recommended CC screening to others. Among 1227 women not screened, main barriers were lack of time (26.0%, 95% CI 21.9-30.6), and lack of motivation (18.3%, 95% CI 14.1-23.3). Overall, 95.6% (95% CI 93.6-97.0) of women reported that they had some knowledge about CC. Knowledge of CC symptoms was low at 34.4% (95% CI 31.0-37.9) and 55.1% (95% CI 51.0-59.1) of participants believed themselves to be at risk of CC.

Conclusion

Most of the survey population had heard about CC. Despite this knowledge, fewer than half of eligible women had been screened for CC. Reasons given for not attending screening can be addressed by programs. To significantly reduce mortality due to CC in Malawi requires a comprehensive health strategy that focuses on prevention, screening and treatment.
Increased condom use among key populations using oral PrEP in Kenya: results from large scale programmatic surveillance
Authors: Manguro Griffins O. , Musau Abednego M. , Were Daniel K. , Tengah Soud , Wakhutu Brian , Reed Jason , Plotkin Marya , Luchters Stanley , Gichangi Peter , Temmerman Marleen
Published: February 2022

Background

Female sex workers (FSW) and men having sex with men (MSM) in Kenya have high rates of HIV infection. Following a 2015 WHO recommendation, Kenya initiated national scale-up of pre-exposure prophylaxis (PrEP) for all persons at high-risk. Concerns have been raised about PrEP users' potential changes in sexual behaviors such adopting condomless sex and multiple partners as a result of perceived reduction in HIV risk, a phenomenon known as risk compensation. Increased condomless sex may lead to unintended pregnancies and sexually transmitted infections and has been described in research contexts but not in the programmatic setting. This study looks at changes in condom use among FSW and MSM on PrEP through a national a scale-up program.

Methods

Routine program data collected between February 2017 and December 2019 were used to assess changes in condom use during the first three months of PrEP in 80 health facilities supported by a scale-up project,Jilinde. The primary outcome was self-reported condom use. Analyses were conducted separately for FSW and for MSM. Log-Binomial Regression with Generalized Estimating Equations was used to compare the incidence proportion (“risk”) of consistent condom use at the month 1, and month 3 visits relative to the initiation visit.

Results

At initiation, 69% of FSW and 65% of MSM reported consistent condom use. At month 3, this rose to 87% for FSW and 91% for MSM. MSM were 24% more likely to report consistent condom use at month 1 (Relative Risk [RR], 1.24, 95% Confidence Interval [CI], 1.18–1.30) and 40% more likely at month 3 (RR, 1.40, 95% CI, 1.33–1.47) compared to at initiation. FSW were 15% more likely to report consistent condom use at the month one visit (RR, 1.15, 95% CI, 1.13–1.17) and 27% more likely to report condom use on the month 3 visit (RR 1.27, 95% CI, 1.24–1.29).

Conclusion

Condom use increased substantially among both FSW and MSM. This may be because oral PrEP was provided as part of a combination prevention strategy that included counseling and condoms but could also be due to the low retention rates among those who initiated.
Effect of social marketing on the knowledge, attitude, and uptake of pap smear among women residing in an urban slum in Lagos, Nigeria
Authors: Olubodun Tope , Balogun Mobolanle Rasheedat , Odeyemi Kofoworola Abimbola , Osibogun Akin , Odukoya Oluwakemi Ololade , Banjo Adekunbiola Aina , Sonusi Sandra Esse , Olubodun Ayodeji Bamidele , Ogundele Oluwatoyin Olanrewaju Progress , Dolapo Duro Clement
Published: February 2022

Introduction

Nigeria has a low uptake of cervical cancer screening and is one of the five countries that represent over half of the global burden of deaths from cervical cancer. Social marketing principles can be used to design and implement interventions to increase uptake of cervical cancer screening. This study assessed the effect of a social marketing intervention on the knowledge, attitude, and uptake of pap smear among women residing in an urban slum in Lagos State, Nigeria.

Materials and methods

This was a quasi-experimental study. The intervention arm consisted of 140 women recruited from Ago-Egun Bariga community and the control arm consisted of 175 women recruited from Oto-Ilogbo extension community. Social marketing intervention was instituted in the intervention group. Data analysis was done using IBM SPSS Statistics version 20 and Stata version 16.0. Between groups comparisons and within groups comparisons were done using bivariate analysis with Chisquare, Students t test and Paired t test as appropriate.

Results

In both the intervention and control groups, the mean knowledge score of cervical cancer was low at baseline (0.0 ± 0.3 and 0.1 ± 0.9 respectively). In the intervention group, there was a significant increase in mean knowledge score to 15.1 ± 3.7, post-intervention (p < 0.001). In both groups, the mean attitude score of cervical cancer was low at baseline (27.1 ± 0.8 in the intervention group and 27.2 ± 1.4 in the control group). In the intervention group, there was a significant increase in mean attitude score to 36.5 ± 4.8, post-intervention (p < 0.001). In both the intervention and control groups, uptake of pap smear was low at baseline (0.0% and 0.6%, respectively). In the intervention group, there was a significant increase in uptake of pap smear to 84.3%, post-intervention (p < 0.001). There was no statistically significant change in knowledge, attitude or uptake of pap smear in the control group, post-intervention.

Conclusion

This study demonstrated that social marketing intervention can be successful in improving knowledge, attitude, and also the uptake of pap smear, even in settings where these are abysmally low. It is recommended that social marketing intervention be employed as a strategy for improving cervical cancer screening among women residing in slums.
Student assistantship programme: an evaluation of impact on readiness to transit from medical student to junior doctor
Authors: Chow Aloysius , Chen Shiwei , Rosby Lucy , Low-Beer Naomi , Shelat Vishalkumar Girishchandra , Cleland Jennifer , Bartlam Bernadette , Smith Helen Elizabeth
Published: February 2022

Background

Studies report that medical graduates are not prepared for practice as expected, and interventions have been developed to prepare them for practice. One such intervention is the assistantship, which provides hands-on opportunities to hone clinical skills and undertake responsibilities under supervision. The Lee Kong Chian School of Medicine (LKCMed) is Singapore’s newest medical school, and students undergo a Student Assistantship Programme (SAP) to prepare for practice as junior doctors (PGY1). This study evaluated the SAP from the students’ and clinical supervisors’ perspectives.

Methods

Students completed online questionnaires to assess readiness for practice before and after SAP, and a subsample were interviewed about their experiences of SAP and its impact on their preparedness for PGY1. In addition, after our graduates had begun work as PGY1 doctors, their clinical supervisors completed an online questionnaire and were interviewed about the perceived benefits of SAP and the attributes of our graduates as junior doctors.

Results

Fifty (96%) students completed the pre-SAP questionnaire and 46 (92%) completed the post-SAP questionnaire. Levels of preparedness increased post-SAP (mean scores range pre-SAP: 2.38 to 4.32 vs post-SAP: 3.08 to 4.48); so did opportunities to undertake PGY1 duties (pre-SAP: 56% vs post-SAP: 96%), and hands-on experience in medical emergencies (pre-SAP: 76% vs post-SAP: 89%).Experience of acute care situations increased except “paracetamol overdose”. Readiness to be first respondents in ten acute situations improved (statistically significant for asthma, chronic obstructive pulmonary disease exacerbation, gastrointestinal bleed, sepsis, and adverse drug reactions). Three themes emerged from twenty-five student interviews: learning about the work environment, opportunities to learn in a safe environment, and enhancing SAP for future students. Thirty-three supervisors completed the questionnaire, and 70% rated SAP positively in preparing students for PGY1. Eight supervisors interviewed shared positively about the content, timing, and duration of SAP; and suggested future SAPs help students to develop coping and reflective skills.

Conclusions

The SAP improved students’ preparedness and experience across clinical areas, and students felt the SAP helped bridge undergraduate curriculum and work, provided opportunities to hone their skills and learn from junior doctors. Most clinical supervisors rated the SAP effective in preparing students for PGY1. This is the first formal evaluation of an assistantship in Singapore, and the findings are encouraging from the perspective of students and PGY1 supervisors.
Strengthening research capacity through an intensive training program for biomedical investigators from low- and middle-income countries: the Vanderbilt Institute for Research Development and Ethics (VIRDE)
Authors: Cassell Holly M. , Rose Elizabeth S. , Moon Troy D. , Bello-Manga Halima , Aliyu Muktar H. , Mutale Wilbroad
Published: February 2022

Background

Capacity strengthening initiatives aimed at increasing research knowledge and skills of investigators in low- and middle-income countries (LMICs) have been implemented over the last several decades. With increased capacity, local investigators will have greater leadership in defining research priorities and impact policy change to help improve health outcomes. Evaluations of models of capacity strengthening programs are often limited to short-term impact. Noting the limitations of traditional output-based evaluations, we utilized a broader framework to evaluate the long-term impact of the Vanderbilt Institute in Research Development and Ethics (VIRDE), a decade-old intensive grant development practicum specifically tailored for investigators from LMICs.

Methods

To assess the impact of VIRDE on the research careers of alumni over the past 10 years, we surveyed alumni on research engagement, grant productivity, career trajectory, and knowledge gained in grant writing. Descriptive statistics, including means and total counts, and paired sample t-tests were used to analyze the data.

Results

Forty-six of 58 alumni completed the survey. All respondents returned to their home countries and are currently engaged in research. Post-VIRDE grant writing knowledge ratings were significantly greater than pre-VIRDE. The number of respondents submitting grants post-VIRDE was 2.6 times higher than before the program. Eighty-three percent of respondents submitted a total of 147 grants post-VIRDE, of which 45.6% were awarded. Respondents acknowledged VIRDE’s positive impact on career growth and leadership, with 88% advancing in career stage.

Conclusions

Gains in grant writing knowledge and grant productivity suggest that VIRDE scholars built skills and confidence in grant writing during the program. A substantial proportion of respondents have advanced in their careers and continue to work in academia in their country of origin. Results show a sustained impact on the research careers of VIRDE alumni. The broader framework for research capacity strengthening resulted in an expansive assessment of the VIRDE program and alumni, illuminating successful program elements and implications that can inform similar capacity strengthening programs.