bluuebunny/crossref_metadata_2025 huggingface dataset:
DOES PRE-HOSPITAL DELAY AFFECT OUTCOMES IN HIP FRACTURE PATIENTS?
Authors: Jambulingam R. , Lloyd J.
Published: July 2024

Background

Hip fractures cost the NHS £2 billion per annum. British guidelines within 36 hours of admission. However, these guidelines do not consider the time the patient spends between injury and admission. Our study aims to investigate pre-hospital time (PHT) and its effect on outcomes. Primary outcome measures were mortality, length of stay (LOS), pressure sores and abbreviated mental test scores (AMTS).

Methods

Hip fracture data was retrospectively collected from our hospital IT system (Clinical Workstation) between February and August 2020. Admission data, ambulance timings, and outcome data was extracted. Statistical analysis was performed using GraphPad Prism V9.5.1.

Results

Two hundred eleven data sets were analysed. Mean age was 82.4, with 2:1 Females to males and median ASA of 3. The mean PHT was 690 minutes (85 to 6057). There was a positive correlation between increased PHT and mortality, though this did not reach statistical significance. There was a significant positive association between PHT and LOS (P=0.0027). Increased PHT was associated with lower admission AMTS (P<0.0001) and higher rate of pressure sore formation (P=0.0001). There was also a significantly positive correlation between PHT and time to mobility (P=0.049).

Conclusion

There is an unobserved delay in hip fracture patients presenting to the hospital. Current treatment guidelines advocate early surgery but do not consider pre-hospital time. PHT in our patient population is 690 minutes on average, with increasing delay correlating with worse outcomes. Pre-hospital time should be considered when managing hip fracture patients with a view to expedite surgery and medical assessment.
EMPLOYMENT OUTCOMES FOLLOWING THORACOLUMBAR FRACTURES: LONG-TERM FOLLOW-UP GREATER THAN FIVE YEARS
Authors: Kimber E. , Allman J. , Dasic D. , Wong F. , McCarthy M.
Published: July 2024

Study design

Retrospective study.

Objectives

To identify patient outcomes, in particular employment, >5-years following traumatic thoracolumbar fracture.

Methods

235 patients between the ages of 18–65 were identified from the hospital radiology database having sustained a traumatic thoracolumbar fracture on CT or MRI between 01/01/2013 and 31/01/2017. Questionnaires were sent out via post and available emails, with a reminder letter and phone calls. Retrospective data was gathered about employment status pre-fracture and >5-years post injury.

Results

26 patients had died at follow up leaving 209 patients. 108 (52%) were treated surgically and 101 (48%) conservatively. 106 replies were received with 85 (80%) opting in and 21 (20%) opting out. 68 (80%) patients completed the full questionnaire with 17 (20%) filling out a shortened questionnaire via a phone conversation. 52 (61%) patients underwent surgery and 33 (39%) were treated conservatively. The average follow up was 8 years. Prior to injury 66 (78%) were employed and 19 (22%) unemployed (of which 6 were full time students and 8 were retired). 49 (74%) of the previously employed patients returned to work at follow up with 35 (53%) working the same or increased hours. Regarding employment, there was no significant difference between surgically and conservatively treated patients (P=0.355) or the classification of the fracture (P=0.303). 16 (19%) patients reported back pain prior to their injury whilst 69 (81%) did not. There were 58 (68%) cases of new pain at follow up with the most affected area being the lumbar region in 43 (51%) patients. 32 (38%) patients reported neurological deficit post injury: 19 with subjective symptoms, 9 with objective symptoms and 4 suffered paralysis.

Conclusion

>5-years following a traumatic thoracolumbar fracture most individuals return to employment. There was no significant difference between the severity of the fracture or how patients are treated on their employment outcomes.
THE LIST: TRANSFORMING THE ORTHOPAEDIC TRAUMA MANAGEMENT AND HANDOVER IN A SUSTAINABLE AND COST-NEUTRAL WAY
Authors: Mohammed F. , Soler A.
Published: July 2024

Trauma, across the United Kingdom, is managed using several software, paper based lists on Microsoft Word/Excel or Teams. There is usually poor handover or no handover in a standard format- during the on call, in the trauma meetings or in the wards. The software in the market for trauma management are not cost friendly or adaptable to local demands. The alternatives like Microsoft WORD based lists are fraught with their own problems. We endeavoured to make our trauma management effective.

A Quality Improvement Project was done. The goals to achieve at end of a year were:

Daily Trauma Handover in standardised format >90%

Ward Handover in standardised format >90%

Availability of outcomes of patients in clinic >80%

Reduction of paper usage >90% at the end of six months

Availability of updated “outliers” information >90% at the weekend ward round

Documentation from the Trauma Meeting > 90%

On-Call documentation in standardised format >90%

Doctor Satisfaction >75% in terms of: ease of us;, searchability of patient; ward round experience; morning trauma meeting experience; handover experience; inter-specialty communication; reliability; daily time saving; on-call time saving; patient care/safety; overall satisfaction.

We used Microsoft Sharepoint List to manage our trauma workload and have named the tool as “The List”. The List has achieved all objectives as above in one year's time, except Outlier information which was at 67% in a recent PDSA (Plan-Do-Study-Act) cycle. The survey showed excellent doctor satisfaction and 90% respondents felt that The List saved an hour or more during the on-call and also during the ward rounds.

We conclude that The List is a very powerful tool making trauma meetings efficient and handover effective. It is indigenous, adaptable, safe, sustainable, cost neutral and easy to use.
THE OUTCOME OF THE PATTERN OF MENISCAL TEARS IN ACL DEFICIENT KNEE
Authors: Al-hasani F. , Mhadi M.
Published: July 2024

Meniscal tears commonly co-occur with ACL tears, and many studies address their side, pattern, and distribution. Few studies assess the patient's short-term functional outcome concerning tear radial and circumferential distribution based on the Cooper et al. classification. Meniscal tears require primary adequate treatment to restore knee function. Our hypothesis is to preserve the meniscal rim as much as possible to maintain the load-bearing capacity of the menisci after meniscectomy.

The purpose of this study is to document the location and type of meniscal tears that accompany anterior cruciate ligament (ACL) tears and their effect on patient functional outcomes following arthroscopic ACL reconstruction and meniscectomy.

This prospective cross-sectional observational study was conducted at AL-BASRA Teaching Hospital in Iraq between July 2018 and January 2020 among patients with combined ipsilateral ACL injury and meniscal tears. A total of 28 active young male patients, aged 18 to 42 years, were included. All patients were subjected to our questionnaire, full history, systemic and regional examination, laboratory investigations, imaging studies, preoperative rehabilitation, and were followed by Lysholm score 6 months postoperatively.

All 28 patients were males, with a mean age of 27 ± 0.14 years. The right knee was the most commonly affected in 20/28 patients (71.4%). The medial meniscus was most commonly injured in 11 patients, 7 patients had lateral meniscal tears, and 10 patients had tears in both menisci. The most common tear pattern of the medial meniscus was a bucket handle tear (36.4%), while longitudinal tears were the most frequent in the lateral meniscus (71.4%) (P-value = 0.04). The most common radial tear location was zone E-F (5/28, 17.8%), and the most common circumferential zone affected was the middle and inner third, reported in 50% of tears. Good and excellent outcomes using the Lysholm score after 6 months were obtained in 42.9% and 17.9% of patients, respectively. Better functional scores were associated with lateral meniscal tears, bucket handle tears, tears extending to a more peripheral vascular area, and if no more than one-third of the meniscus was resected (P-value = 0.002). Less favourable outcomes were reported in smokers, posterior horn tears, and when surgery was delayed more than 1 year (P-value = 0.03).

We conclude that there is a negative correlation between the amount of meniscus resected and functional outcome. Delayed ACL reconstruction increases the risk of bimeniscal tears. Bucket handle tears are the most common tears, mostly in the medial meniscus, while longitudinal tears are most common in the lateral meniscus. We recommend performing early ACL reconstruction within 12 months to reduce the risk of bimeniscal injuries.
Assessing the Impact of the 2012 National Student Loan Forgiveness on Rural Health Human Resources
Authors: Grignon Michel , Liu Qian , Bai Yihong , Etoom Balqis
Published: July 2024

On 1 January 2013, the federal Canada Student Financial Assistance Program (then known as the Canadian Student Loan Program) granted loan forgiveness to family physicians or nurses working at least 400 hours a year in a “rural” area of Canada. This is a return-for-service (RFS) program forgiving a maximum amount of the loan for each year worked in a designated area, up to a maximum of five years. The goal of the policy was to attract more family physicians and nurses to underserved areas and address the inequality in health between rural and urban areas in the country. The policy was accepted on principle but raised issues of non-compatibility between the federal and provincial RFS to attract health care workers to underserved areas, in particular its blanket definition of those areas as “rural,” whereas provincial programs use criteria based on the density of physicians or nurses per population.
Le 1er janvier 2013, le Programme canadien d’aide financière aux étudiants (connu à l’époque sous le nom de Programme canadien de prêts étudiants), a accordé une exonération aux médecins de famille et personnels infirmiers travaillant au moins 400 heures par an dans une région « rurale » du Canada. Il s’agit d’une d’obligation de retour de service (RDS) exonérant d’un montant maximum du prêt pour chaque année travaillée dans une région désignée, pour un maximum de cinq ans. L’objectif de cette politique était d’attirer davantage de médecins de famille et de personnels infirmiers dans les régions mal desservies et de remédier à l’inégalité de santé entre les zones rurales et urbaines du pays. La politique a été acceptée sur le principe, mais a soulevé des questions d’incompatibilité entre les RDS provinciaux et fédéraux visant à attirer des personnels infirmiers dans les zones mal desservies, en particulier sa définition générale des zones comme « rurales », alors que les programmes provinciaux utilisent des critères basés sur la densité de médecins ou de personnels infirmiers par rapport à la population.
Im/mobility as a form of gender-based violence: the case of transnationally abandoned wives in India
Authors: Yalamarty Harshita , Anitha Sundari , Roy Anupama
Published: July 2024

Transnational marriage abandonment (TMA) of women is a growing form of violence reported across India and South Asia. The spouse, most commonly a husband, lives and works in a foreign country and exploits the advantages derived from his citizenship or visa status to exercise coercion and control over the immigrating wife. TMA takes different forms, including when a woman is left behind with the in-laws while waiting for the husband to provide visa sponsorship for her migration. Such women are vulnerable to financial precarity, isolation and domestic violence from in-laws, may be dispossessed from their marital home and served with ex parte divorces.

Drawing on life-history interviews with 35 ‘never-migrant’ women conducted between 2013 and 2016, and subsequent policy and legal developments in India and the UK, this article seeks to unpack the gendered dimensions of im/mobility within TMA. Women’s immobilisation results from state migration policies, legal obstacles, patriarchal socio-cultural norms and purposive actions by husbands and their families to perpetually defer visa sponsorship and extract labour and/or money from women. Our findings indicate that immobilisation is a key facet of violence against women and legal responses to TMA must utilise a gender-based violence framework that can incorporate immobilised ‘never-migrant’ women.
A handmaid’s tale? Support for surrogacy reform: experimental evidence from Britain
Authors: Turnbull-Dugarte Stuart J.
Published: July 2024

Aspiring parents who are unable to have biological children increasingly rely on gestational surrogacy. This practice, while long-standing, remains controversial. Despite domestic prohibitions, several states are considering liberalising access to the process. Surrogacy regulations are complex. Debates on potential reforms are often multidimensional and raise issues about, among other features, access to bodily agency, economic compensation and exploitation, and transnational trafficking. This article leverages a pre-registered conjoint experiment in Britain, where surrogacy reforms are actively being pursued, to identify which regulatory features can garner public support. The results indicate higher levels of public support for reforms that offer moderate financial compensation, facilitate access for non-heterosexual couples, permit overseas surrogacy arrangements, require legally binding guardianship transfers from birth and have cross-party backing. Subgroup analysis shows minimal gender-based differences but some large differences based on respondents’ sexuality, identity and partisanship.
Who does technology serve? A critical analysis of sociocultural factors shaping opportunities, practices and barriers faced by a smallholders in south-western Colombia
Authors: Ramos Marcela , Triana Natalia , Burkart Stefan , Gutiérrez Jhon Freddy , Gutiérrez-Zapata Diana María , Ruden Alejandro , Sepúlveda Lady , Barrett Brian
Published: July 2024

This article offers a critical approach towards adopting new technologies as a mitigation strategy. It provides a comprehensive analysis that helps illuminate the adoption process and the sociocultural factors intersecting and informing it. Using a capability approach lens and qualitative and participatory data collection methods, this study presents and analyses the testimonies of smallholders living on Colombia’s Pacific coast, currently exposed to a series of interventions that promote changes in production decisions to contribute to reducing national greenhouse gas emissions. Specifically, improved forages, silvopastoral systems and new practices, such as the implementation of rotational pasturing, have been promoted as relevant new approaches. The results show that access to new technologies generates new capabilities, for instance the ability to plan for the challenges imposed by climate change or to develop new strategies to allow the soil to recover naturally. However, these new possibilities are unevenly distributed, creating disadvantages for groups that generally experience conditions of vulnerability, such as young farmers and women. The testimonies also show that many of the promoted initiatives emphasise the need for adaptation and change on the part of smallholders without considering the limitations of technology, the gender issues that affect the inclusion of women and the dynamics that set barriers to young smallholders due to economic restrictions or power issues. Therefore, the study contends that, when understanding technology adoption, it is not only a question of what farmers do or do not do but of what they can be and do in increasingly demanding contexts.
Variabilidad en la práctica de la psicología clínica ambulatoria en el servicio madrileño de salud
Authors: Cuellar Flores Isabel , Fernández Garzón Lucía , Ferreira González Mercedes , Félix-Alcántara Miriam , De la Vega Rodríguez Irene , Manzano Olivares Beatriz , Palacios Albarsanz M. Luz , Maldonado Belmonte M. Jesús , Jiménez Bruña Miriam
Published: July 2024

La variabilidad en la práctica clínica en psicología clínica en España es ha sido escasamente estudiado. Este estudio describe la variabilidad en las respuestas asistenciales de Psicología Clínica en los Centros y consultas externas de Salud Mental de la Comunidad de Madrid, a través de una encuesta informada por 120 psicólogos/as clínicos/as del Servicio Madrileño de Salud, y analizar factores que puedan relacionarse con ella. El riesgo de mala salud mental del área de salud se relaciona con una lista de espera más larga y realización de grupos de psicoterapia. La renta media del área de salud y los años de experiencia se asociaron a una mayor probabilidad de realizar grupos. La gestión privada de los dispositivos se asoció con una menor duración de las primeras consultas y sucesivas y con una demora temporal entre consultas mayor. Se discuten las implicaciones de estos resultados.
Exploring Educational Neuroscience as a Professional Practice
Authors: Nouri Ali
Published: July 2024

Educational neuroscience can be viewed in a twofold manner: as a field of study and as a profession. This review is specifically focused on exploring educational neuroscience as a profession, arguing that depicting its professional landscape is of equal significance to the understanding of its disciplinary boundaries. Accordingly, when educational neuroscientists have the necessary training and skills to provide educational services to individuals, groups, or organizations, they should be legally authorized and receive the same licensure and recognition benefits as their peers from other disciplines. It is not argued that every educational neuroscientist is or should be a professional practitioner. However, providing a specific job description for educational neuroscience professionals may facilitate their efforts to secure positions that fully utilize their skills and expertise.
El impacto de la Neuroeducación en el abordaje de las Necesidades Educativas Especiales: reforzando a inclusión con paradigmas actuales
Authors: Contreras Paredes Norton
Published: July 2024

La Neuroeducación ha cobrado especial relevancia en los últimos años. En base a este concepto, que proviene de la Neurociencia, se ha intentado comprender cómo aprenden los seres humanos y cuáles son los fundamentos neurobiológicos que sostienen este proceso. Los aportes de esta área han sido sustantivos, considerando su injerencia en el ámbito de la Educación Especial, específicamente en las Necesidades Educativas Especiales. Es así como en el presente trabajo se dará a conocer una perspectiva actualizada sobre esta relación conceptual, comenzando por los orígenes del concepto de Necesidades Educativas Especiales, el rol de la Neurociencia como eje que direcciona el surgimiento de la Neuroeducación y el rol de esta última como directriz en el trabajo que los profesionales de la neurorrehabilitación realizan a diario con las personas con las cuales trabajan. Finalmente, se dará a conocer una serie de neuromitos que se encuentran, de una u otra forma, vinculados con el trabajo en Necesidades Educativas Especiales y que contribuyen a considerar perspectivas realistas y actualizadas con miras a fortalecer los procesos de enseñanza y aprendizaje en las personas que se encuentran en estas condiciones. De este modo se busca además generar un panorama reflexivo y crítico frente a esta relevante temática que, a través del tiempo, ha generado cada vez más impacto en los procesos educativos.
Machado de Assis against the Grain: Satire, Memoir and the Erasure of Slavery in Memorial de Aires
Authors: Brunette Vinicius C.
Published: July 2024

Abstract: Memorial de Aires [ Counselor Ayres' Memorial ] (1908), the last book by Machado de Assis, has been seen either as the last scraping of the pot by an outdated author or a masterpiece in which the writer's obsession with death is investigated by proxy by the narrator, Aires. In his memoir, the retired diplomat Aires reveals little of himself, claims he has no political leanings, and narrates a plot with few incidents which ends with a predicable wedding between young people of the same social class. By reading the novel against the grain, this article suggests that the tenuous book of memories can be seen as a novel full of life, in which the apparent tedium and tendency to claim to rise above the conflicts can be read as a sharp criticism, disguised as farce, of the numerous memoirs of this period made by 'great Brazilians' aiming to shape the future and erase the historical reality of slavery. Resumo: Memorial de Aires (1908), o último livro de Machado de Assis, foi visto ou como a raspa do tacho de um escritor desatualizado ou como obraprima em que a obsessão do escritor com a morte é investigada por procuração pelo narrador Aires. Em seu memorial, o diplomata aposentado Aires revela pouco sobre si, garante não ter lado político e narra um enredo com poucos acontecimentos que culmina com um casamento esperado entre jovens do mesmo meio social. Ao ler o romance a contrapelo, este artigo sugere que o tênue livro de memórias pode ser visto como um romance cheio de vida, com o aparente tédio e a tendência de alegar estar acima dos conflitos podendo ser lidos como uma afiada crítica em chave de farsa da produção memorialística do período feita por 'grandes brasileiros' na busca por pastorear o futuro e apagar o histórico da escravidão.
A Band Apart Together: Pulp Fiction and Reservoir Dogs as Deleuzian Assemblages
Authors: Barrett Kyle
Published: July 2024

Abstract: This article will examine Quentin Tarantino's Reservoir Dogs (1992) and Pulp Fiction (1994) within the context of Gilles Deleuze and Félix Guattari's notions of the "assemblage," complex multiplicities that are composed of disparate elements to produce specific effects. It will be argued that Tarantino consistently demonstrates a preoccupation with meta, postmodernist filmmaking, illustrated through nonlinear narrative strategies. When examined in tandem, both films share numerous elements which can be understood as "rhizomatic" connections that form the foundation of Tarantino's singular practice that continues to fascinate and influence to this day.
Problems and Prospects in Elementary Particle Research
Authors: Wheeler John Archibald
Published: July 2024

Abstract: Now that the broad principles of the science of nuclear transformations have become clear and this field has found important practical applications, it has become the task of science to explore the physics of the elementary particles. The purpose of this paper is to survey the outstanding problems and to discuss possible lines of investigation. Specific questions now at issue are: (1) the genetic relationship between the radiations found in nature-neutrons, protons, electrons, positrons, mesons, neutrinos, photons; (2) what possibilities exist for the transformation of one of these entities into another in the cosmic radiation and in stellar interiors; (3) what energies and intensities of bombardment are required to bring about appreciable numbers of these transformations; (4) which changes appear susceptible to study by artificial sources of high energy radiation now in prospect; (5) for which transformations does the cosmic radiation appear to be the only effective source which will be available for some time to come; (6) what can be done to make out of high altitude cosmic radiation a workaday source for elementary particle research; (7) what modifications are required in the field concept to describe gravitation, electromagnetism, the creation of electron-positron pairs and the forces between elementary particles in a unified manner, unambiguously and without divergences; (8) how stable are neutrons and protons, and what is the possibility to convert their entire mass into energy?
To the Life: Resurrection and Presence in The Second Maiden’s Tragedy , Hamlet , and Fat Ham
Authors: Robertson Lauren
Published: July 2024

Abstract: Occupying a central place in Jacques Derrida’s formulation of hauntology, Hamlet ’s Ghost is familiar to contemporary performance theory, standing in for the secondariness and self-division that define dramatic representation. But there was another figure more emblematic of performance in the early modern English playhouse: the revenant. Examining the convention of resurrection as it was frequently deployed in this theatre, this essay uncovers the capacity of the revenant to generate presence, the visceral sense of theatrical immediacy first championed by Antonin Artaud. Following readings of The Second Maiden’s Tragedy and Hamlet , it concludes with a coda on James Ijames’s Fat Ham (2023), a play that adopts the early modern theatre’s resurrective praxis of presence.
A Visceral and Temporal Remix: Performing Reza Abdoh’s Archives
Authors: Akhtari Nazli
Published: July 2024

Abstract: This essay takes as its central concern the historical transmission of Reza Abdoh’s performance works via their circulation in the artist’s retrospective exhibit at the KW Institute for Contemporary Art in 2019. I analyze two interlaced defining features in the KW exhibition—archival remixing and viscerality—that the curators used to honor Abdoh’s artistic legacy. Focusing on the exhibit as a medium of performance historiography in diaspora, this essay argues that the multimedia installation of Abdoh’s archival work in the exhibition format utilized performance archives to create a haptic and visceral site of historiography and memory.
Social Democracy and the Birth of Working-Class Representation in Europe
Authors: Mor Maayan , Boix Carles
Published: July 2024

abstract: Despite the growing interest in the economic backgrounds of mps in Western Europe, the evolution of working-class numerical representation before 1945 has not been systematically studied. Using data from England and Wales (1832–1944), Germany (1871–1930), and Norway (1906–1936), the authors show both that working-class mps were elected when barriers were lowered and that almost all working-class parliamentarians were affiliated with socialist parties. The authors further probe the conditions that determined the electoral success of workers using data about all candidates, constituencies’ occupational profile, and unionization in Norway between 1906 and 1936. They find that socialist parties nominated workers either in relatively uncompetitive elections in which unionization was high or in competitive races in which the party’s victory was possible but not guaranteed. Using information about mps in Germany and England and Wales, the authors find similar patterns. The article discusses the implications for research about democratization, the rise of social democracy, and the numerical representation of workers.
Ultra-efficient surface grating couplers for chip-to-fiber and chip-to-free-space coupling based on single-beam radiation
Authors: Sánchez-Postigo Alejandro , Ginel Pablo , Schmid Jens , Hadij-ElHouati Abdelfettah , Ortega-Moñux Alejandro , Wangüemert-Pérez J. Gonzalo , Halir Robert , Cheben Pavel , Molina-Fernandez Inigo
Published: July 2024

Surface grating couplers, such as fiber-chip grating couplers and optical antennas, are fundamental devices in photonic integrated circuits, as they enable the coupling of light between the chip and an external medium. An important metric of surface grating couplers is the coupling efficiency, and high values, greater than -1 dB, are required for applications in quantum technology, light detection and ranging, and optical interconnects. Surface grating couplers typically suffer from radiation loss to the substrate, which substantially limits their coupling efficiency. Here we propose a novel grating-coupling concept that utilizes a high-refractive-index upper cladding to frustrate radiation orders to the substrate by operating in a single-beam diffraction regime. To illustrate this concept, we report the design of an easily fabricable silicon surface grating coupler with an unprecedented coupling efficiency of -0.20 dB to a single-mode optical fiber. Furthermore, the proposed strategy allows us to design an evanescently coupled millimeter-long optical antenna with virtually 0-dB coupling efficiency to free-space. Additionally, an ultra-fast wavelength-tunable beam steering of 0.37º/nm is achieved, which corresponds to more than a 2.5-fold enhancement over comparable silicon antennas. These results represent a pathway for a new set of photonic integrated interfaces for applications in which high-efficiency chip-to-fiber and chip-to-free-space coupling is critical.
Uncertainty in tuberculosis clinical decision-making: An umbrella review with systematic methods and thematic analysis
Authors: Basile Francesca Wanda , Sweeney Sedona , Singh Maninder Pal , Bijker Else Margreet , Cohen Ted , Menzies Nicolas A. , Vassall Anna , Indravudh Pitchaya
Published: July 2024

Tuberculosis is a major infectious disease worldwide, but currently available diagnostics have suboptimal accuracy, particularly in patients unable to expectorate, and are often unavailable at the point-of-care in resource-limited settings. Test/treatment decision are, therefore, often made on clinical grounds. We hypothesized that contextual factors beyond disease probability may influence clinical decisions about when to test and when to treat for tuberculosis. This umbrella review aimed to identify such factors, and to develop a framework for uncertainty in tuberculosis clinical decision-making. Systematic reviews were searched in seven databases (MEDLINE, CINAHL Complete, Embase, Scopus, Cochrane, PROSPERO, Epistemonikos) using predetermined search criteria. Findings were classified as barriers and facilitators for testing or treatment decisions, and thematically analysed based on a multi-level model of uncertainty in health care. We included 27 reviews. Study designs and primary aims were heterogeneous, with seven meta-analyses and three qualitative evidence syntheses. Facilitators for decisions to test included providers’ advanced professional qualification and confidence in tests results, availability of automated diagnostics with quick turnaround times. Common barriers for requesting a diagnostic test included: poor provider tuberculosis knowledge, fear of acquiring tuberculosis through respiratory sampling, scarcity of healthcare resources, and complexity of specimen collection. Facilitators for empiric treatment included patients’ young age, severe sickness, and test inaccessibility. Main barriers to treatment included communication obstacles, providers’ high confidence in negative test results (irrespective of negative predictive value). Multiple sources of uncertainty were identified at the patient, provider, diagnostic test, and healthcare system levels. Complex determinants of uncertainty influenced decision-making. This could result in delayed or missed diagnosis and treatment opportunities. It is important to understand the variability associated with patient-provider clinical encounters and healthcare settings, clinicians’ attitudes, and experiences, as well as diagnostic test characteristics, to improve clinical practices, and allow an impactful introduction of novel diagnostics.
Disparities and factors affecting hypertension diagnosis from qualified doctors in Bangladesh and its impact on receiving hypertension control advice: Analysis of demographic & health survey 2017–18
Authors: Kibria Gulam Muhammed Al , Rahman Shawon Md Shajedur , Hashan Mohammad Rashidul , Khan Maryam Hameed , Gibson Dustin G.
Published: July 2024

The burden of hypertension is increasing in many low- and middle-income countries, including Bangladesh, and a large proportion of Bangladeshi people seek healthcare from unqualified medical practitioners, such as paramedics, village doctors, and drug store salesmen; however, there has been limited investigation regarding diagnosis and care provided by qualified doctors. This study investigated the factors associated with hypertension diagnosis by qualified doctors (i.e., registered medically trained doctors or medical doctors with at least an MBBS degree) and how this diagnosis is related to hypertension-controlling advice and treatment among Bangladeshi adults. This cross-sectional study used data from Bangladesh Demographic and Health Survey 2017–18. After describing sample characteristics, we conducted simple and multivariable logistic regression analyses to investigate the associated factors and associations. Among 1710 participants (68.3% females, mean age: 50.1 (standard error: 0.43) years) with self-reported hypertension diagnosis, about 54.9% (95% confidence interval (CI): 51.8–58.0) had a diagnosis by qualified doctors. The following variables had significant associations with hypertension diagnoses from qualified doctors: 40-54- or 55-year-olds/above (ref: 18-29-year-olds), overweight/obesity (ref: not overweight/obese), college/above education (ref: no formal education), richest wealth quintile (ref: poorest), urban residence (ref: rural), and residence in Chittagong, Barisal, and Sylhet divisions (ref: Dhaka division). Lastly, compared to people who had not been diagnosed by qualified doctors, those with the diagnosis from qualified doctors had higher odds of receiving any hypertension-controlling advice and treatment, including drugs (1.73 (95% CI: 1.27–2.36), salt intake reduction (AOR: 2.36, 95% CI: 1.80–3.10), weight reduction (AOR: 2.58, 95% CI: 1.97–3.37), smoking cessation (AOR: 2.22, 95% CI: 1.66–2.96),), and exercise promotion (AOR: 2.34, 95% CI: 1.77–3.09). This study showed significant socioeconomic and rural-urban disparities regarding hypertension diagnosis from qualified doctors. Diagnosis by qualified doctors was also positively associated with receiving hypertension-controlling advice and treatment. Reducing these inequalities would be crucial to reducing the country’s hypertension burden.
Quantitative CT lung volumetry and densitometry in pediatric pectus excavatum
Authors: Song Yeong Ran , Im Soo Ah
Published: July 2024

The purpose of this study was to evaluate the quantitative computed tomography (CT) volumetry and densitometry and in pediatric patients with pectus excavatum (PE). We measured pectus index (PI) and separated inspiratory and expiratory lung volumes and densities. We obtained the total lung volume (TLV) and mean lung density (MLD) during inspiration and expiration, and the ratio of end expiratory to inspiratory volume (E/I volume) and MLD (E/I density) were calculated. The difference between inspiratory and end expiratory volume (I-E volume) and MLD (I-E density) were also calculated. A total of 199 patients, including 164 PE patients and 35 controls, were included in this study. The result shows that the PE group had lower inspiratory TLV (mean, 2670.76±1364.22 ml) than the control group (3219.57±1313.87 ml; p = 0.027). In the PE group, the inspiratory (-787.21±52.27 HU vs. -804.94±63.3 HU) and expiratory MLD (-704.51±55.41 HU vs. -675.83±64.62 HU) were significantly lower than the indices obtained from the control group (p = 0.006). In addition, significantly lower values of TLV and MLD difference and higher value of TLV and MLD ratio were found in the PE group (p <0.0001). PE patients were divided into severe vs. mild groups based on the PI cutoff value of 3.5. The inspiratory MLD and TLV ratio in the severe PE group were lower than those in the mild PE group, respectively (p <0.05). In conclusion, quantitative pulmonary evaluation through CT in pediatric PE patients may provide further information in assessing the functional changes in lung parenchyma as a result of chest wall deformity.
Novel identification of mixed infection of Lactococcus garvieae and Cryptocaryon irritans isolated from cultured Trachinotus ovatus in China
Authors: Huang Yucong , Sun Heng , Dong Jun , Zhang Jianrong , Wang Haoyu , Yang Lindi , Li Yanping , Wang Yifan
Published: July 2024

Lactococcus garvieae has recently been identified and listed as one of the causative agents of hyperacute hemorrhagic sepsis in fish. In intensive recirculating aquaculture systems where there are high fish densities and minimal water changes, not only will it be conducive to the growth of bacteria, but Cryptocaryon irritans as a marine protozoan fish parasite is also prone to appear. This study reports the disease status of Trachinotus ovatus in an aquaculture area in Yangjiang City, Guangdong Province. Through the diagnosis of clinical symptoms of the diseased fish, identification of specific primers, 16s rRNA sequences phylogenetic tree analysis, physiological and biochemical identification, and observation of histopathological sections, the result of the experiment is that the mass death of T. ovatus is caused by a mixture of L. garvieae and C. irritants infections. Subsequently, regression infection experiments were performed to verify Koch’s law. It was confirmed that the pathogen had strong virulence to T. ovatus. This is the first time that the co-infection of L. garvieae and C. irritans to T. ovatus was found in South China. The research results of this experiment have certain enlightenment significance for the epidemic trend of fish diseases in relevant sea areas.
Polycyclic aromatic hydrocarbons content of food, water and vegetables and associated cancer risk assessment in Southern Nigeria
Authors: Nsonwu-Anyanwu Augusta Chinyere , Helal Mohamed , Khaked Azza , Eworo Raymond , Usoro Chinyere Adanna Opara , EL-Sikaily Amany
Published: July 2024

The polycyclic aromatic hydrocarbon content of water (four surface water, six underground water (borehole water), seven sachet water), barbecued food and their fresh equivalents (barbecued beef, fish, plantain, pork, yam, chicken, chevon, potato, corn), oil (three palm oil, nine vegetable oil), and fresh vegetable samples (water leaf, bitter leaf, cabbage, carrot, cucumber, pumpkin, garlic, ginger, green leaf, Gnetum Africana, onion, pepper) were determined by GC-MS analysis. The current study also determined the estimated lifetime cancer risk from ingesting polycyclic aromatic hydrocarbon-contaminated food. The polycyclic aromatic hydrocarbon content of water, oil, vegetable, and food samples were within the United States Environmental Protection Agency/World Health Organization safe limits. The naphthalene, benzo(b)fluoranthene, and benzo(k)fluoranthene levels in surface water were significantly higher than in borehole samples (P = 0.000, 0.047, 0.047). Vegetable oils had higher anthracene and chrysene compared to palm oil (P = 0.023 and 0.032). Significant variations were observed in levels of naphthalene, acenaphthylene, phenanthrene, benzo(b)fluoranthene, benzo(k)fluoranthene, benzo(a)pyrene, and dibenzo(a,h)anthracene among the barbecued and fresh food samples (P <0.05). Barbecued pork, potato, and corn had significantly higher naphthalene compared to their fresh equivalents (P = 0.002, 0.017, and <0.001). Consumption of barbecued food and surface water may be associated with higher exposure risk to polycyclic aromatic hydrocarbons which may predispose to increased cancer health risk. The current work explores in depth the concentration of polycyclic aromatic hydrocarbons in different dietary categories that pose direct risk to humans via direct consumption. These findings add knowledge to support future considerations for human health.
Effect of tracheotomy timing on patients receiving mechanical ventilation: A meta-analysis of randomized controlled trials
Authors: Han Rongrong , Gao Xiang , Gao Yongtao , Zhang Jihong , Ma Xiaoyan , Wang Haibo , Ji Zhixin
Published: July 2024

Purpose

We assessed the effects of tracheostomy timing (early vs. late) on outcomes among adult patients receiving mechanical ventilation.

Methods

PubMed, Embase, Web of Science and Cochrane Library were searched to identify relevant RCTs of tracheotomy timing on patients receiving mechanical ventilation. Two reviewers independently screened the literature, extracted data. Outcomes in patients with early tracheostomy and late tracheostomy groups were compared and analyzed. Meta-analysis was performed using Stata14.0 and RevMan 5.4 software. This study is registered with PROSPERO (CRD42022360319).

Results

Twenty-one RCTs were included in this Meta-analysis. The Meta-analysis indicated that early tracheotomy could significantly shorten the duration of mechanical ventilation (MD: -2.77; 95% CI -5.10~ -0.44; P = 0.02) and the length of ICU stay (MD: -6.36; 95% CI -9.84~ -2.88; P = 0.0003), but it did not significantly alter the all-cause mortality (RR 0.86; 95% CI 0.73~1.00; P = 0.06), the incidence of pneumonia (RR 0.86; 95% CI 0.74~1.01; P = 0.06), and length of hospital stay (MD: -3.24; 95% CI -7.99~ 1.52; P = 0.18).

Conclusion

In patients requiring mechanical ventilation, the tracheostomy performed at an earlier stage may shorten the duration of mechanical ventilation and the length of ICU stay but cannot significantly decrease the all-cause mortality and incidence of pneumonia.
Does the use of statins alter the risk of rheumatoid arthritis? A systematic review and meta-analysis
Authors: Pan Xinhong , Yang Xiaobing , Ma Peiying , Qin Li
Published: July 2024

Objective

Statins have anti-inflammatory and immune-modulatory effects which could alter the risk of rheumatoid arthritis (RA). We reviewed published literature and conducted a meta-analysis to examine if statins have an impact on the risk of RA.

Methods

Case-control studies, cohort studies, or randomized controlled trials (RCT) published on the PubMed, Scopus, and EMBASE databases up to 30th October 2023 were searched. The association between statin use and risk of RA was pooled in a random-effects meta-analysis.

Results

Nine studies (four cohort, four case-control, and one RCT) were included. Overall, the analysis failed to note an association between the use of statins and the risk of RA with the pooled OR being 0.93 (95% CI 0.82, 1.06). High heterogeneity was noted with I2 = 75%. Results were consistent across study types with no association noted between prior statin use and risk of RA in case-control studies (OR: 0.88 95% CI: 0.69, 1.13), cohort studies (OR: 1.01 95% CI: 0.92, 1.10), and the lone RCT (OR: 1.40 95% CI: 0.50, 3.92).

Conclusion

Current literature shows that there is no association between the use of statins and the risk of RA. Further rigorous studies taking into account patient factors, duration of statin exposure, and other confounders are needed to generate better evidence.
Effects of intermittent pneumatic compression devices interventions to prevent deep vein thrombosis in surgical patients: A systematic review and meta-analysis of randomized controlled trials
Authors: Kim Nam Young , Ryu Seang , Kim Yun-Hee
Published: July 2024

This review aimed to determine the effectiveness of Intermittent Pneumatic Compression (IPC) intervention on Deep Vein Thrombosis (DVT) in surgical patients. An electronic database search was conducted with PubMed, OVID-MEDLINE, EMBASE, and CENTRAL, from September 22 to 28, 2023. Three researchers independently selected the studies, assessed their methodological quality, and extracted relevant data. We conducted a meta-analysis of the effect of IPC versus the control group and summarized the intervention results from the included studies. Of the 2,696 articles identified 16 randomized control trials met the inclusion criteria for review. IPC interventions significantly affected DVT prevention (OR = 0.81, 95% CI: 0.59–1.11). In the subgroup analysis, there was a significant pooled effect (OR = 0.41, 95% CI: 0.26–0.65]), when the comparison group was no prophylaxis group. However, when the comparison groups were the pharmacologic prophylaxis group ([OR = 1.32, 95% CI 0.78–2.21]) and IPC combined with the pharmacologic prophylaxis group (OR = 2.43, 95% CI: 0.99–5.96) did not affect DVT prevention. The pooled effects of Pulmonary Embolism (PE) (OR = 5.81, 95% CI: 1.25–26.91) were significant. IPC intervention showed a significant effect on bleeding prevention (OR = 0.17, 95% CI: 0.08–0.36) when compared to IPC combined with the pharmacologic groups. IPC intervention effectively prevented DVT, PE, and bleeding in surgical patients. Therefore, we propose that IPC intervention be applied to surgical patients to avoid DVT, pulmonary embolism, and bleeding in the surgical nursing field as scientific evidence suggests.
Herrera de Pisuerga, un gran centro importador del Noroeste peninsular. La evidencia de las ánforas de San Millán
Authors: Pérez González Cesáreo , Arribas Lobo Pablo , Carreras Monfort Cèsar
Published: July 2024

La variedad y la cantidad de las ánforas halladas en el yacimiento de San Millán lo convierten en la excavación con la mayor densidad de este tipo de restos documentada hasta ahora en el conjunto arqueológico de Herrera de Pisuerga, en la provincia de Palencia. Este estudio muestra la rica variedad de sus tipos –con un predominio de los contenedores vinarios sobre los dedicados al transporte de salazones y aceite–, así como de sus lugares de procedencia: provincias Tarraconense y Bética, Mar Egeo y Mediterráneo oriental, península itálica –costas adriática y tirrénica–, Gallia –área narbonense– y producciones regionales.
Por otro lado, y a partir de esta información, se intenta explicar cómo se produjo el abastecimiento al campamento de la legio IIII Macedonica en Herrera de Pisuerga de los productos contenidos en estos recipientes, así como las rutas seguidas, analizando las relaciones comerciales y las características del transporte que implican a la Hispania Citerior Tarraconensis en los momentos finales de la conquista del área NO peninsular y su posterior urbanización.
Nuevas dataciones para la Edad del Bronce en la cuenca alta del Tajo. La cueva de la Noguera (Val de San García, Cifuentes, Guadalajara)
Authors: Cerrillo-Cuenca Enrique , Álvarez-Alonso David , Alcaraz-Castaño Manuel
Published: July 2024

La transición del III al II milenio cal AC en la cuenca alta del Tajo cuenta con escasas dataciones radiométricas, a pesar de disponer de un notable registro arqueológico. La aportación de nuevas dataciones contribuye a asentar puntos de referencia para contextos con cerámica campaniforme y los primeros atribuibles a la Edad del Bronce, una realidad que se ha vuelto especialmente compleja en las últimas décadas. En esta noticia damos a conocer cuatro nuevas dataciones radiométricas que proceden de un contexto de finales del III milenio cal AC excavado en la cueva de la Noguera (Val de San García, Cifuentes). Este contexto nos sirve para actualizar la información sobre las dinámicas culturales que se observan en el área de Guadalajara.
Las nuevas dataciones subrayan la complejidad de la transición entre el III y el II milenio cal AC en la parte central de la Península Ibérica, resaltando la diversidad en las formas de ocupación del paisaje. A su vez, la cueva de la Noguera muestra una modalidad de vida en cuevas que parece consistente con otras ocupaciones en la Meseta. La fauna recuperada y los materiales encontrados en la superficie exterior de la cueva indican un posible uso agroganadero de la ubicación.
A Internyet comunista: Análise sobre a (não) consolidação da rede de computadores na União Soviética (1958-1991)
Authors: Santos Junior Roberto Lopes dos
Published: July 2024

Análise sobre a evolução e desenvolvimento dos projetos ligados à consolidação do sistema / rede de computadores na União Soviética entre os anos 1950 e 1980. O foco do estudo está nas propostas precursoras do militar Anatoly Kitov no final dos anos 1950, e do ambicioso projeto proposto pelo pesquisador Viktor Glushkov, a partir do Sistema Estatal de Gerenciamento Automatizado (OGAS), que almejou criar uma complexa rede de computadores na URSS, discutidos entre 1962-1970 e parcialmente rejeitados. Por fim, discutem-se as iniciativas localizadas, e muitas vezes fragmentadas, apresentadas pelo partido comunista nos anos 1970 e 1980. A pesquisa identificou que, apesar das ideias pioneiras de inserção de uma rede de computadores, anos antes das iniciativas feitas no Estados Unidos, os projetos acabaram entrando em choque com a excessiva centralização econômica e administrativa na União Soviética, gerando forte oposição dos ministérios ligados ao partido comunista, atingindo diretamente o OGAS, definindo assim o insucesso do programa