bluuebunny/crossref_metadata_2025 huggingface dataset:
xtgeebcv: A command for bias-corrected sandwich variance estimation for GEE analyses of cluster randomized trials
Authors: Gallis John A. , Li Fan , Turner Elizabeth L.
Published: June 2020

Cluster randomized trials, where clusters (for example, schools or clinics) are randomized to comparison arms but measurements are taken on individuals, are commonly used to evaluate interventions in public health, education, and the social sciences. Analysis is often conducted on individual-level outcomes, and such analysis methods must consider that outcomes for members of the same cluster tend to be more similar than outcomes for members of other clusters. A popular individual-level analysis technique is generalized estimating equations (GEE). However, it is common to randomize a small number of clusters (for example, 30 or fewer), and in this case, the GEE standard errors obtained from the sandwich variance estimator will be biased, leading to inflated type I errors. Some bias-corrected standard errors have been proposed and studied to account for this finite-sample bias, but none has yet been implemented in Stata. In this article, we describe several popular bias corrections to the robust sandwich variance. We then introduce our newly created command, xtgeebcv, which will allow Stata users to easily apply finite-sample corrections to standard errors obtained from GEE models. We then provide examples to demonstrate the use of xtgeebcv. Finally, we discuss suggestions about which finite-sample corrections to use in which situations and consider areas of future research that may improve xtgeebcv.
Vascular Complications in the Era of Transcatheter Treatment of Adult Structural Heart Disease: A Single-Center Early Experience
Authors: Wehbe Mohammad Rachad , Sawaya Fadi , Sabra Mohamad , Hamadi Caroline , Hoballah Jamal , Haddad Fady
Published: June 2020

Transcatheter treatment is becoming the mainstay treatment for structural heart diseases (SHD) in prohibitive surgical risk patients. Recently with the encouraging results, it is being offered to regular risk patients. Peripheral vascular complications (VCs) are still inherent to these procedures due to the nature of this atherosclerotic high-risk group and the profile of the devices. This is a single-center early first year experience with such events occurring after initiating a SHD program treating severe aortic stenosis, aortic regurgitation, mitral valve prolapse and regurgitation, as well as paravalvular leaks. Out of 33 patients in this time period, 5 developed PV complications which are detailed in this article with their associated risk factors and management. These include access-related complications, closure device issues, arterial rupture post device embolization, and vessel dissection. Vascular complications of those procedures take special interest since they are associated with a worse long-term prognosis. Thus, prevention with proper planning remains of essence along with multidisciplinary management.
Ultrasound-Guided Fibrin Glue Injection for Treatment of Iatrogenic Femoral Pseudoaneurysms
Authors: Gummerer Maria , Kummann Moritz , Gratl Alexandra , Haller Daniela , Frech Andreas , Klocker Josef , Fraedrich Gustav , Gruber Hannes
Published: June 2020

Introduction:

Arterial pseudoaneurysms (PSAs) are the most common access site complication following transarterial catheter intervention. Ultrasound-guided injection of thrombogenic substances into perfused arterial PSAs followed by compression therapy is a well-established and less invasive treatment option than surgical repair. Different agents are available to induce thrombosis including thrombin and a fibrin-based tissue glue, which is used as first-line treatment at our institution. This paper deals with our experience using ultrasound-guided fibrin glue injection (UGFI).

Materials and Methods:

Retrospective data analysis: all patients (55) treated for iatrogenic femoral PSA following digital subtraction angiography of the lower extremities between January 1, 2010, and December 31, 2018, were included. Data on epidemiology, PSA location and size, vascular risk factors, fibrin glue injection (fibrin glue volume), primary success rate of UFGI, and complications related to the treatment were analyzed.

Results:

A total of 55 consecutive femoral iatrogenic PSAs were treated during the defined period and 32 (58.2%) of the patients were female. Imaging was performed using ultrasound in all cases. The most common PSA location (80.0%) was the common femoral artery, mean PSA size (± SD) was 2.7 ± 1.2 cm, and neck length was 1.6 ± 1.0 cm. The dose (mean ± SD) of fibrin glue was 2.6 mL (± 1.0; maximum: 6 mL). Primary UGFI success rate was 87.3% and conversion rate to open surgery was 12.7%. Two (4%) patients required embolectomy for peripheral embolization after UGFI.

Conclusion:

Early results achieved with UGFI for treatment of iatrogenic femoral PSA are promising. In our cohort, UGFI was a safe and effective first-line alternative to traditional open surgery, which then was unnecessary in the vast majority of PSA cases. Further prospective studies for comparison of ultrasound-guided techniques should be encouraged.
Materials selection of “green” natural fibers in polymer composite automotive crash box using DMAIC approach in Six Sigma method
Authors: Yusof NSB , Sapuan SM , Sultan MTH , Jawaid M
Published: June 2020

This article presents the results of research in selecting the most appropriate natural fibers to be used as reinforcement (normally in the hybrid form) in polymer composites for the automotive crash box by carrying out the materials selection process using the Six Sigma method. The judgment based on results from Six Sigma integrated two decision methods, which were applied using two different approaches in decision making: qualitative method and quantitative method. In this study, oil palm fiber had been proposed as the most appropriate natural fiber to be selected as reinforcement in composite automotive crash box. The DMAIC approach from the Six Sigma method performed an important role by providing various tools for each phase in the material selection process. The final selection process led to selection of oil palm fiber as the best natural fiber to reinforce polyurethane as polymeric matrices due to the satisfaction of all the selection criteria.
Physical properties of single jersey derivative knitted cotton fabric with tuck and miss stitches
Authors: Assefa Alemayehu , Govindan Nalankilli
Published: June 2020

The effect of different stitch combinations, namely, knit, tuck and miss stitches, on some of the physical properties of single jersey derivative fabrics have been studied. Fabrics which are in common commercial use in the textile industry were selected, and they are used as clothing fabrics. Knitted fabrics from 100% cotton yarn of 19.67 Tex on circular knitting machines were used in the study. The effect of knit structure on areal density, fabric thickness, air permeability, drape ability, stretch and recovery, shrinkage, and low-stress mechanical properties are investigated, and it was found that these properties are significantly affected by loop shape or knit structure, even though other knitting parameters remained the same. It was also found that the presence of tuck and float stitches for a given structure have a significant effect on fabric drape ability, width-wise extensibility, length-wise shrinkage, thickness, areal density and low-stress mechanical properties.
Working the Limits of “Giving Voice” to Children: A Critical Conceptual Review
Authors: Facca Danica , Gladstone Brenda , Teachman Gail
Published: June 2020

Although claims to “give voice” to children through qualitative inquiry seem morally just and have been largely framed by good intentions, critical scholarship has called for reflexive reconsiderations of such claims. Re/presentations of voice permeate published accounts of qualitative research with children; similarly, voice is a term invoked frequently in qualitative research with informants of all ages. In this article, we follow Spyrou’s notion of “troubling” to review, critique, and synthesize key works by critical child-focused scholars who have reflexively queried and worked with the epistemological and methodological limits of “giving voice” to children through qualitative inquiry. Building on the reviewed literature, as well as poststructural approaches to framing voice in research more generally, we briefly discuss how we have built on these critiques in our own research. In so doing, we join ongoing dialogues aimed at generating alternative approaches to theorizing and re/presenting children’s perspectives in qualitative inquiry more justly.
The kinematic design of mold clamping mechanism with minimal maximum acceleration
Authors: Hsieh Long-Chang , Chen Tzu-Hsia , Lai Po-Cheng
Published: June 2020

Typically, the motion of the output link of the mode clamping mechanism has reciprocating linear motion, but the motion of the input link can be reciprocating rocking motion or reciprocating linear motion. In addition, the mold clamping mechanism must have a dead-position configuration for the mold at the closed position. This article focuses on the kinematic design of a mold clamping mechanism having an input link with reciprocating linear motion and having dead-position configuration at closed positions. First, four design concepts of mold clamping mechanisms are proposed based on the mechanism creative design methodology. Then, one of the design concepts is chosen as the design example to illustrate the kinematic design of the mode clamping mechanism with minimal maximum acceleration. According to the design requirements, the best design of the mode clamping mechanism of this article is better than the existing patent by reducing 43.5% acceleration and 18.6% driving force.
A new multiaxial fatigue life prediction model considering additional hardening effect
Authors: Bin Li , Jianhui Liu , Xiuli Wang
Published: June 2020

The established linear fatigue life prediction model based on the Miner rule has been widely applied to fatigue life prediction under constant amplitude uniaxial and multiaxial loading. Considering the physical significance of crack formation and propagation, a multiaxial equivalent linear fatigue life prediction model is put forward based on Miner rule and critical plane method under constant amplitude loading. The essence of this approach is that the equivalent strain, which consists of the shear strain and normal strain on the critical plane, replaces the relevant parameter of uniaxial nonlinear fatigue damage model. The principal axes of stress/strain rotate under non-proportional loading. Meanwhile, the microstructure of material and slip systems change, which lead to additional hardening effect. The ratio of cyclic yield stress to static yield stress is used to represent the cyclic hardening capacity of material, and the influence of phase difference and loading condition on the non-proportional hardening effect is considered. The multiaxial fatigue life is predicted using equivalent stain approach, maximum shear stain amplitude model, CXH model, and equivalent multiaxial liner model under proportional and/or non-proportional loading. The smooth and notched fatigue specimens of four kinds of materials (Q235B steel, titanium alloy TC4, Haynes 188, and Mod.9Cr-1Mo steel) are used in the multiaxial fatigue experiments to verify the proposed model. The predicted results of these materials are compared with the test results, and the results show that these four models can achieve good effect under proportional loading, but the proposed model performs better than the other three models under non-proportional loading. Meanwhile, it also verifies that the proposed enhancement factor can reflect the influence of phase difference and material properties on additional hardening.
Loeys–Dietz syndrome pathology and aspects of cardiovascular management: A systematic review
Authors: Iqbal Rizwan , Alom Samiha , BinSaeid Jalal , Harky Amer
Published: June 2020

Loeys–Dietz syndrome is an autosomal dominant genetic disorder which is associated with significant and often crucial vascular manifestations. This review is aimed to examine current evidence on pathophysiology and management of Loeys–Dietz syndrome in current era. A comprehensive electronic search was done to identify the articles that discussed all the aspects of Loeys–Dietz syndrome, combined key words and Medical Subject Headings (MeSH) terms were used. Relevant articles have been summarized in each relevant section. Loeys–Dietz syndrome is an autosomal dominant genetic disorder which has combined and multi-systemic manifestations. The increased breakdown of extracellular matrix predisposes an individual to developing aneurysms in the aortic tree which is undoubtedly the most significant complication of this disorder. Understanding the pathophysiology and natural history of Loeys–Dietz syndrome and regular surveillance is important to plan prophylactic interventions to prevent life-threatening aortic emergencies which can be fatal. Loeys–Dietz syndrome is an aggressive genetic condition that predisposes an individual to the development of life-threatening aortic aneurysms. Our understanding of Loeys–Dietz syndrome remains ever-changing and it is likely that the knowledge regarding its diagnosis and treatment will become more clearly defined in the coming years with deeper genetic studies.
‘Al Faza’a’ leadership: An implicit cultural barrier to distributed leadership in Jordanian public schools
Authors: Hashem Reem
Published: June 2020

In 2003, the Jordanian government launched an ‘education reform for knowledge economy’ leadership programme in Jordanian public schools. The programme transformed school leadership structures by advocating patterns of distributed leadership. However, growing evidence in cross-cultural research shows the influence of local culture on implementation of foreign reform programmes. This paper aims to examine a culture-bound leadership practice during the implementation of the education reform for knowledge economy programme and the tensions it holds to the intent of distributed leadership. This leadership practice was identified by Jordanian school principals who participated in qualitative research to examine factors affecting the implementation of the education reform for knowledge economy programme. The research employed a grounded theory methodology for data collection and analysis. Principals termed this leadership practice ‘al faza’a’ leadership which is anchored in al faza’a social practice of Jordanian tribes. Findings demonstrate that Jordanian tribal leadership styles are seen in Jordanian public schools. ‘Al faza’a’ hegemonic leadership practices in the Jordanian public schools signify the embodiment of the tribal social and cultural values of solidarity and kinship. These values can be incongruent with the core values underlying the education reform for knowledge economy’s advocated distributed leadership programme. This paper concludes that ‘al faza’a’ practice can represent an implicit leadership theory in Jordanian schools.
On-site monitoring of clinical trials by an Ethics Committee in India: a road less travelled
Authors: Shafiq Nusrat , Kumari Savita , Kumar Vivek , Suri Vinita , Jayashree Muralidharan , Duseja Ajay , Bansal Arun , Malhotra Samir
Published: June 2020

Monitoring of clinical trials is important to ensure adherence to protocol, to safeguard the rights of research participants and to achieve compliance with principles of good clinical practice. Recent regulatory changes in India require Ethics Committees to keep an oversight of ongoing clinical trials including on-site monitoring. In this article, we share the experience of on-site monitoring of clinical trials by the Ethics Committee of a tertiary care, academic and research centre in India. We found a large number of shortcomings in the areas of informed consent, adverse events, insurance and reimbursement, which would not have been detected by off-site document review. Interestingly, many shortcomings were also not detected by on-site monitoring arranged by clinical trial sponsors. We therefore conclude that on-site monitoring of ongoing clinical trials is a highly important activity for Indian Ethics Committees.
Time analysis of throwing motions to second base by baseball catchers: Comparison of three throwing motions
Authors: Kawabata Koichi , Urata Tatsuya , Fukuda Koji , Tanabe Satoru
Published: June 2020

The purpose of this study was to investigate a baseball catcher’s throwing time to second base using three throwing motion types. The subjects were professional ( n = 4) and college ( n = 12) baseball catchers. Two high-speed cameras were set to capture the throwing motion, while one was set to capture the net on second base. The throwing time of quick throw (throwing motion to release the ball immediately after catching the ball rather than usual throwing motion) was significantly shorter than those of usual throw (throwing motion used during games and practice) and fast ball throw (throwing motion to increase the ball velocity than usual throwing motion). From this result, it became clear that quick throw is the optimal throwing motion when judged by time. Thus, with respect to correlations between variables, there were significant positive correlations between throwing and motion times (usual throw: r = 0.760; fast ball throw: r = 0.719; quick throw: r = 0.767), and between throwing and airborne times (usual throw: r = 0.784; fast ball throw: r = 0.744; quick throw: r = 0.806), for all three throwing motions. However, negative correlations were shown between throwing and release times in usual throw and fast ball throw. The results suggest that, to shorten the throwing time, it is necessary to shorten the hold and stride times and to improve the ability to throw the ball as fast as possible with a shorter motion time.
The impact of humanistic coach training on youth athletes’ development through sport
Authors: Falcão William R , Bloom Gordon A , Sabiston Catherine M
Published: June 2020

The purpose of this study was to evaluate the impact of humanistic coach training on athletes’ developmental outcomes. A sample of 148 high school student-athletes between 12 and 17 years old from low socio-economic communities completed questionnaires during their season. The student-athletes were divided into an experimental group composed of student-athletes of 11 head coaches who participated in a humanistic coach training session, and a comparison group composed of student-athletes of 8 untrained coaches. Four questionnaires were used to assess competence, confidence, connection to the coach, and character (prosocial and antisocial behaviours) of the participants. The effects of the humanistic coach training program were assessed using repeated measures analysis of variance models. Results showed that connection to the coach worsened for athletes of untrained coaches. Also, participants from both groups reported an increase in antisocial behaviours at the end of the season, but the athletes of trained coaches reported engaging less frequently in antisocial behaviours compared to athletes of untrained coaches. These findings suggest that teaching humanistic coaching may help practitioners foster positive developmental outcomes in youth sport participants and build positive coach-athlete relationships, while also raising awareness to the use of sport as a tool to promote personal growth and development.
Tapering practices of elite CrossFit athletes
Authors: Pritchard Hayden J , Keogh Justin W , Winwood Paul W
Published: June 2020

This is the first study to document the training and tapering practices of elite CrossFit athletes. Seventy-two CrossFit athletes (39 females, 33 males) (mean ±SD; 26.5 ± 3.6 y, 167.1 ± 9.5 cm, 74.5 ± 12.7 kg, 12.8 ± 6.5 y general training, 5.4 ± 1.7 y CrossFit training) who competed at the “Regionals” level or higher in the 2018 CrossFit Games season completed a self-reported 5-page online survey. Almost all athletes (98.6%) tapered before important competitions. Taper length was 5.4 ± 2.7 days, with the step and linear tapering styles being most commonly utilised. Strength training volume peaked 5.1 ± 4.6 weeks before competition, whereas conditioning training volume peaked 4.0 ± 4.4 weeks before competition. Strength training intensity peaked 3.1 ± 2.4 weeks before competition, whereas conditioning training intensity peaked 2.8 ± 2.2 weeks before competition. Almost all athletes (90.0%) reduced training duration during tapering, but changes to frequency and intensity were mixed. Training volume decreased by 41.2 ± 15.5% during the taper, all training ceased 2.0 ± 1.1 days before competition. Tapering was performed to achieve peak performance, recover (physically and psychologically), and reduce feelings of fatigue. Poor results from tapering were experienced when athletes tapered for too long or insufficiently. This observational data may be valuable for coaches and athletes engaged in CrossFit as well as other sports with concurrent training and competition demands.
A data-driven approach for the health prognosis of high-speed train wheels
Authors: Chi Zhexiang , Zhou Taotao , Huang Simin , Li Yan-Fu
Published: June 2020

Polygonal wear is one of the most critical failure modes of high-speed train wheels that would significantly compromise the safety and reliability of high-speed train operation. However, the mechanism underpinning wheel polygon is complex and still not fully understood, which makes it challenging to track its evolution of the polygonal wheel. The large amount of data gathered through regular inspection and maintenance of Chinese high-speed trains provides a promising way to tackle this challenge with data-driven methods. This article proposes a data-driven approach to predict the degree of the polygonal wear, assess the reliability of individual wheels and the health index of all wheels of a high-speed train for maintenance priority ranking. The synthetic minority over-sampling technique—nominal continuous is adopted to augment the maintenance dataset of imbalanced and mixed features. The autoencoder is used to learn abstract features to represent the original datasets, which are then fed into a support vector machine classifier. The approach is coherently optimized by tuning the model hyper-parameters based on Bayesian optimization. The effectiveness of our proposed approach is demonstrated by the wheel maintenance data obtained from the year 2016 to 2017. The results can also be used to support practical maintenance priority allocation.
Reliability-based evaluation of hybrid wind–solar energy system
Authors: Devrim Yilser , Eryilmaz Serkan
Published: June 2020

In this article, a hybrid system that consists of a specified number of wind turbines and solar modules is considered. In particular, the system is modeled using weighted k-out-of- n system which is also known as a threshold system in reliability literature. The system under concern consists of [Formula: see text] identical wind turbines and [Formula: see text] identical solar modules, and each turbine and module can be in one of two states as working or failed. The probability that the entire hybrid system with [Formula: see text] components produces power at minimum level k is computed and evaluated. The importance of single-wind turbine and solar module is also calculated to measure which renewable energy component is more critical and important. Extensive numerical results that are based on real data set are presented to illustrate the model.
Competing discourses of power in teachers’ stories of challenging relationships with students
Authors: Chamberlain Rachel , Scales Peter C , Sethi Jenna
Published: June 2020

Student–teacher relationships have been largely explored in literature from the perspective of successful relationships, i.e., what constitutes a successful relationship and how teachers build them. However, in moments of student defiance, resistance or pushback, how do teachers react? When teachers recount such moments, is the narrative one describing the teacher’s attempt to maintain authority and order, or do teachers provide a different narrative when recounting how they dealt with these difficult moments with students? This study seeks to identify narratives of power in teachers’ discourse within their stories about challenges in their relationships with students. Challenging relationships among teachers and students can stem from a struggle with power. Findings from the study examine how teachers use discourse to position themselves and their students within structures of power when reflecting on difficult or challenging relationships with students. The stories in this study contain some evidence of students’ resistance in refusing to meet teachers’ expectations or by pushing back on a teacher’s behaviour. Yet, teachers struggled to balance their authority and share power with students to negotiate a solution.
Optimal treatment strategy for metastatic melanoma patients harboring BRAF-V600 mutations
Authors: Giunta Emilio Francesco , De Falco Vincenzo , Napolitano Stefania , Argenziano Giuseppe , Brancaccio Gabriella , Moscarella Elvira , Ciardiello Davide , Ciardiello Fortunato , Troiani Teresa
Published: June 2020

BRAF-V600 mutations occur in approximately 50% of patients with metastatic melanoma. Immune-checkpoint inhibitors and targeted therapies are both active as first-line treatments in these patients regardless of their mechanisms of action and toxicities. However, an upfront therapeutic strategy is still controversial. In fact, waiting for results of ongoing clinical trials and for new biomarkers, clinicians should base their decision on the clinical characteristics of the patient and on the biological aspects of the tumor. This review provides an overview on BRAF-V600 mutations in melanoma and will discuss their prognostic and clinical significance. Moreover, it will suggest a therapeutic algorithm that can drive therapeutic choice in a first-line setting for BRAF-V600 mutant melanoma patients.
Impact of COVID-19 on orthopaedic care: a call for nonoperative management
Authors: Phillips Mark R. , Chang Yaping , Zura Robert D. , Mehta Samir , Giannoudis Peter V. , Nolte Peter A. , Bhandari Mohit
Published: June 2020

Background:

Surgical specialties face unique challenges caused by SARS-COV-2 (COVID-19). These disruptions will call on clinicians to have greater consideration for non-operative treatment options to help manage patient symptoms and provide therapeutic care in lieu of the traditional surgical management course of action. This study aimed to summarize the current guidance on elective surgery during the COVID-19 pandemic, assess how this guidance may impact orthopaedic care, and review any recommendations for non-operative management in light of elective surgery disruptions.

Methods:

A systematic search was conducted, and included guidance were categorized as either “Selective Postponement” or “Complete Postponement” of elective surgery. Selective postponement was considered as guidance that suggested elective cases should be evaluated on a case-by-case basis, whereas complete postponement suggested that all elective procedures be postponed until after the pandemic, with no case-by-case consideration. In addition, any statements regarding conservative/non-operative management were summarized when provided by included reports.

Results:

A total of 11 reports from nine different health organizations were included in this review. There were seven (63.6%) guidance reports that suggested a complete postponement of non-elective surgical procedures, whereas four (36.4%) reports suggested the use of selective postponement of these procedures. The guidance trends shifted from selective to complete elective surgery postponement occurred throughout the month of March. The general guidance provided by these reports was to have an increased consideration for non-operative treatment options whenever possible and safe. As elective surgery begins to re-open, non-operative management will play a key role in managing the surgical backlog caused by the elective surgery shutdown.

Conclusion:

Global guidance from major medical associations are in agreement that elective surgical procedures require postponement in order to minimize the risk of COVID-19 spread, as well as increase available hospital resources for managing the influx of COVID-19 patients. It is imperative that clinicians and patients consider non-operative, conservative treatment options in order to manage conditions and symptoms until surgical management options become available again, and to manage the increased surgical waitlists caused by the elective surgery shutdowns.
Using the Middle Turbinate to Protect the Skull Base in Endoscopic Transsphenoidal Surgery: A Cadaver Study
Authors: Shah Janki , Tang Dennis , Grafmiller Kevin , Cappello Zachary J. , Roxbury Christopher , Sindwani Raj
Published: June 2020

Objectives

Inadvertent intracranial injury from nasogastric tube (NGT) placement is a described and potentially fatal complication following endoscopic transsphenoidal hypophysectomy (TSH). This cadaver study assessed the role of middle turbinate (MT) preservation and medialization in preventing accidental skull base injury from NGT insertion after TSH. Methods: Standard approach for TSH was performed on 3 human cadavers. MTs were placed into neutral position (MTN), then medialized via suture pexy to the septum (MTP), and subsequently resected (MTR). After each stage, 3 blinded individuals passed a 10 F Dobhoff and a 16 F NGT on each side of each cadaver (5 passes per side). Using endoscopic visualization, each pass was scored by a blinded reviewer based on the first contact point of the tube (0 = nasopharynx, 1 = inferior sphenoid face, 2 = sphenoid sinus), with higher scores suggestive of increased risk of intracranial injury. Results: There were 270 Dobhoff and 270 NGT passes scored. Data was divided into 3 groups based on presence and position of the MT. Significant differences were demonstrated between all three groups [one-way ANOVA: Dobhoff F(2,267) = 6.981, p = 0.001], [NGT F(2,267) = 17.582, p < 0.001]. There were significant differences between means for MTN versus MTP groups [Dobhoff (0.43 vs 0.22, p = 0.007), NGT (0.73 vs 0.28, p < 0.001)] and MTP versus MTR groups [Dobhoff (0.22 vs 0.55, p < 0.001), NGT (0.28 vs 0.81, p < 0.001)], indicating that the presence and position of the MT can significantly affect the accessibility of the sphenoid sinus interior after TSH. There was a trend toward lower means in the MTN group compared to the MTR group. Conclusion: MT preservation and deliberate medialization against the septum may reduce risk of inadvertent intracranial NGT injury in postop TSH patients. This simple maneuver should be considered in all routine TSH procedures.
Reaping More Than What They Sow: A Critical Race Perspective on Environmental Microaggressions Toward Latinx Farmworkers
Authors: Areguin Maira A. , Huynh Que-Lam , Berzenski Sara R.
Published: June 2020

There are 3+ million farmworkers in the 132.8-billion-dollar U.S. agricultural industry, most of whom are Latinx. Latinx farmworkers possess at least two marginalized identities, class and ethnicity, which expose them to prejudice and discrimination. Drawing from a critical race perspective, we proposed that prejudice and discrimination are experienced interpersonally and subtly embedded within the social and physical environments for Latinx farmworkers (i.e., environmental microaggressions (EMs)). Further, we hypothesized that farmworker-specific EMs would be associated with health. Data from 90 Latinx farmworkers ( M age = 46.09 years, 63.3% women) partly supported our hypotheses. Results revealed interesting patterns of association with depression and anxiety symptoms, and physical function. Findings underscore the need to examine classism and racism as intersecting systemic forces in the lives of Latinx farmworkers, some of the most vulnerable peoples within U.S. American society.
Antimicrobial stewardship programs; a two-part narrative review of step-wise design and issues of controversy Part I: step-wise design of an antimicrobial stewardship program
Authors: Resman Fredrik
Published: June 2020

Regardless of one’s opinion of antimicrobial stewardship programs (ASPs), it is hardly possible to work in hospital care and not be exposed to the term or its practical effects. Despite the term being relatively new, the number of publications in the field is vast, including several excellent reviews of general and specific aspects. Work in antimicrobial stewardship is complex, and includes not only aspects of infectious disease and microbiology, but also of epidemiology, genetics, behavioural psychology, systems science, economics and ethics, to name a few. This review aims to take several of these aspects and the scientific evidence of antimicrobial stewardship studies and merge them into two questions: How should we design ASPs based on what we know today? And which are the most essential unanswered questions regarding antimicrobial stewardship on a broader scale?

This narrative review is written in two separate parts aiming to provide answers to the two questions. This first part is written as a step-wise approach to designing a stewardship intervention based on the pillars of unmet need, feasibility, scientific evidence and necessary core elements. It is written mainly as a guide to someone new to the field. It is sorted into five distinct steps: (a) focusing on designing aims; (b) assessing performance and local barriers to rational antimicrobial use; (c) deciding on intervention technique; (d) practical, tailored design including core element inclusion; and (e) evaluation and sustainability. The second part, published separately, formulates ten critical questions on controversies in the field of antimicrobial stewardship. It is aimed at clinicians and researchers with stewardship experience and strives to promote discussion, not to provide answers.
Alemtuzumab-related thyroid disease in people with multiple sclerosis is associated with age and brainstem phenotype at disease onset
Authors: Yap Siew Mei , Dillon Mary , Crowley Rachel K , McGuigan Christopher
Published: June 2020

Background

Autoimmune thyroid disease (AITD) occurs in 40%–50% of alemtuzumab-treated persons with multiple sclerosis (pwMS), most of whom will develop Graves’ Disease (GD).

Objective

To explore contributory factors for alemtuzumab-related AITD in pwMS.

Methods

A retrospective patient chart review was performed.

Results

Sixteen out of 52 (30.8%) pwMS developed AITD. GD occurred in 56.3% ( n = 9), the majority ( n = 7, 77.8%) symptomatic. All but one (85.7%) pwMS with symptomatic GD developed atypical, large and rapid fluctuations in thyroid hormone levels unexplained by effect of anti-thyroid medication alone. All symptomatic GD cases were age ≤32 years when starting alemtuzumab (ɸ = 0.60, p = 0.03). PwMS who started alemtuzumab at a younger age developed thyroid disease earlier ( r = 0.51, p = 0.04). PwMS with clinical and radiological evidence of brainstem involvement at onset of multiple sclerosis were 11 times more likely to develop symptomatic GD compared with those with other phenotypes ( p < 0.01).

Conclusion

Alemtuzumab-induced reconstitution GD may result from early and increased cross-reactivity between antigens common to the brainstem and thyroid, or presence of shared Human Leukocyte Antigen (HLA) alleles that determine brainstem and thyroid involvement. We suggest cautious use of alemtuzumab in younger (≤32 years) pwMS with early brainstem involvement, especially those actively planning pregnancy, where alternative therapies are readily available.
The importance of addressing ageism in Swedish healthcare
Authors: Sjögren Forss Katarina
Published: June 2020

Ageism is discrimination against individuals or groups based on their age. In the Swedish healthcare context, the term is uncommon, despite the fact that older people are a significant class of users. One of every five individuals in Sweden is 65 years of age or older, and the proportion of older people in the population is rising. Therefore, ageism in healthcare warrants more awareness and focus. In three recent articles that we have published relating to nutritional, depression and continence care for older people, we found indications of ageism even though we did not aim to study it. There is a need to identify the manifestations of ageism and label them, and to become alert to both the visible and invisible expressions of ageism. This will help in the development of interventions and policies to eliminate ageism in healthcare. With health inequalities growing and seemingly becoming the norm rather than the exception in Sweden and other European countries, it has become imperative to address and eliminate health inequalities through a range of initiatives and mechanisms. Fighting ageism in different settings must be a part of this larger goal.
Positive effects of ferric iron on the systemic efficacy of nephrilin peptide in burn trauma
Authors: Mascarenhas Desmond D , El Ayadi Amina , Ravikumar Puja , Kang Gyeong Jin , Langer Tammy , Moreno Carlos , Amento Edward P
Published: June 2020

Introduction:

Nephrilin peptide is a designed inhibitor of Rictor complex (also known as mTORC2), an evolutionarily conserved assembly believed to modulate responses to cellular stress. We previously demonstrated the ability of nephrilin peptide to suppress neuroinflammation, loss of body mass, glycaemic control and kidney function in a rat scald model, as well as sepsis mortality in a mouse model. The present study explores the effect of nephrilin plus iron formulations on clinically relevant outcomes in the rat scald model.

Methods:

Animals were treated with nephrilin by subcutaneous bolus injection on post-burn days 1–7. Equimolar ferric iron in the formulation improved the positive systemic effects of nephrilin on kidney function, glycaemic control, oxidative stress, early hyperinflammation, late inflammasome activation, hyperangiogenesis and body mass, all variables previously shown to bear upon clinically relevant burn injury outcomes. The sparing effects of nephrilin-iron were demonstrated in both sexes.

Discussion:

Surprisingly, optimum daily treatment doses were in the range of 2–4 mg/kg, while 8 mg/kg was less effective, suggesting the possibility of marginal pro-oxidant effects from the ‘free’ iron fraction. Thus, although ferric iron in the nephrilin formulation is clearly helpful, care must be exercised to select an optimum treatment dose.

Conclusion:

Iron increases the efficacy of nephrilin peptide in burns.
The Relationship Between Orthographic Awareness and Chinese Reading in Hong Kong’s Young CSL Learners
Authors: Wong Yu Ka
Published: June 2020

Purpose:

This study investigates young Chinese as a second language (CSL) learners’ Chinese character reading performance and its relationship with their orthographic awareness. There is a pressing need to gain a better understanding of Hong Kong’s ethnic minority students’ CSL acquisition, so that more effective instruction can be provided.

Design/Approach/Methods:

A total of 157 Hong Kong ethnic minority CSL students in Grade 4 were evaluated using a range of assessments: orthographic awareness in identifying and utilizing character components, listening comprehension for vocabulary terms and short texts, and reading Chinese character lists with single- and two-character words.

Findings:

The students performed consistently across the two lists but made fewer errors when reading the two-character word list, most of which were orthographical. Multiple regression analysis showed that the students’ orthographic awareness contributed significantly to their character reading.

Originality/Value:

The findings suggest that orthographic awareness can help ethnic minority CSL learners improve their Chinese character reading skills. Chinese classes provided for such students, and for CSL learners in general, should place greater focus on literacy training.
The Impact of Workplace Environments on Retention Outcomes of Public Universities in Southern Nigeria
Authors: Salau Odunayo , Worlu Rowland , Osibanjo Adewale , Adeniji Anthonia , Falola Hezekiah , Olokundun Maxwell , Ibidunni Stephen , Atolagbe Tolulope , Dirisu Joy , Ogueyungbo Opeyemi
Published: June 2020

Universities, across the globe, are identified as complex and critical engines for sustainable development. Nigerian universities have recorded success stories and breakthroughs, but they have their teething problems of retention and challenges which tend to impede their position on the world education league table. Retention of employees in the work environment has attracted a lot of attention from scholars in different fields of study to curb the trend of turnover intentions, human capital flight and redundancy of academia in Nigeria. Hence, this paper investigates the impact of workplace environments on the retention of the academic staff of public universities, Southern-Nigeria. The study adopted a cross-sectional and descriptive approach to elicit information from 384 academic staff that were randomly and purposively selected. The use of a modified questionnaire (quantitative) was adopted. The quantitative data were analysed using Structural Equation Modelling (SEM_PLS) to obtain results. The findings indicated that the issue of inadequate and decay of infrastructural facilities had been a concern to the sampled universities. Many lecturers, including professors, shared offices that are dilapidated, poorly ventilated and furnished. The results indicated an increasing pauperization, varying promotion criteria, erratic power supply, over-congested classrooms and a growing disparity in the ratio between teaching staff and students. Due to its consequences, strategies for curbing this menace in state universities, such as the creation of enabling environment, adequate funding of tertiary education, effective administration and motivation of staff of the sampled institutions, among others were proffered.
An Experimental Investigation Into the Application of a Learning-From-Mistakes Approach Among Freshmen Students
Authors: Lee Wing Shing
Published: June 2020

To achieve a more effective teaching method, an experimental study using a learning-from-mistakes approach was investigated. A novel approach was adopted from organizational learning literature involving two steps. A first step established the psychological safety notion in students, and the second step called for a student discussion of mistakes they had made. Two classes of freshmen university students studying basic accounting participated in this study. One class was assigned as the treatment group, whereas the other the control group. Students’ performance was repeatedly measured on three separate occasions: pretreatment test, midterm examination, and a final examination as the posttest. Results showed that students from the treatment group outperformed those in the control group on the latter two occasions, whereas both groups scored similarly in the pretreatment test. It is thus concluded that such a suggested approach may ultimately help students learn more effectively.
Practice Teaching to Teaching Practice: An Autoethnography of Early Autonomy and Relatedness in New Teachers
Authors: Soleas Eleftherios K. , Code Mary A.
Published: June 2020

The first steps that new teachers take in their classrooms lead them down a path that presents many challenges, and these challenges are the reason that beginning teachers are a vulnerable population in the context of educational practitioners. This autoethnography examines two new teachers as they transition from their teacher education programs to teaching in the classroom. This research frames their experiences using the perspective of self-determination theory to characterize the psychological nature of beginning teachers’ challenges as they transition into a community of educational practice. Participants reported how they perceived feeling ill-prepared for the realities of classrooms and provide ideas on what desired changes in teacher education might look like. The novel contribution of this study highlights intervention sites for alleviating the unique vulnerability of the newest teachers as they make a difficult transition from practice teaching to teaching practice.
Prepectoral Implant-Based Breast Reconstruction Using Meshed ADM
Authors: Fin Alessandra , De Biasio Fabrizio , Mura Sebastiano , Massarut Samuele , Zaccaria Giovanna , Parodi Pier Camillo
Published: June 2020

Prepectoral prosthetic breast reconstruction has been widely reassessed in recent years and is taking on an increasingly important role in the field of immediate breast reconstruction. We report here a case series of 32 patients who underwent nipple-sparing mastectomy for breast carcinoma and prepectoral breast reconstruction involving an acellular dermal matrix (ADM) treated by means of a skin-graft mesher in our hospital from January 2015 to March 2016. The indications for this type of reconstruction were body mass index (BMI) less than 30 kg/m2; no history of radiotherapy; no active smokers; moderate grade breast; and good viability of mastectomy flap: normal skin colour, active bleeding at the fresh cut edges, and thicker than 1 cm mastectomy flaps; the viability of lower thicknesses was ascertained by the fluorescent dye indocyanine green xenon-based imaging technology (4 patients). The mean age of the patients was 56.4 years (range: 39-77 years). Their mean BMI was 27.4 kg/m2. Until the end of follow-up (mean: 17 months), major complications requiring reoperation occurred in 9% of patients and minor complications in 22% of patients. The mean of the 3 pain visual analogue scale scores taken in the first 24 hours after surgery was 1.8. Mean duration of hospital stay has been 2.2 days. Our complication rate was similar to those reported in other studies on prepectoral breast reconstruction featuring total ADM coverage of the implant.
Assessing Diabetes Risk Factors in Rural Dwelling Grandparent Caregivers
Authors: Smalls Brittany L. , Adegboyega Adebola , Contreras Omar A. , Palmer Kelly , Hatcher Jennifer
Published: June 2020

Objective:

The purpose of this study is to assess type 2 diabetes mellitus (T2DM) risk factors in grandparent caregivers living in a rural environment.

Methods:

Clinical measures (hemoglobin A1c [HbA1c], blood pressure, and lipids) and self-reported data on social environment factors were attained. Data were analyzed via Pearson’s correlation and regression models.

Results:

By clinical definition of diabetes (HbA1c ≥ 6.5%), 21% were prediabetic and 28% had undiagnosed T2DM. There was an association between the number of individuals in the home and triglycerides ( r = −.25), high-density lipoproteins (HDL; r = .43), and body mass index (BMI; r = .39). Guardianship status had a significant association with BMI ( r = −.38). There was a significant association between low-density lipoprotein (LDL; r = −.32) and access to community shared resources. In the adjusted linear model, the number of grandchildren in the home had a significant relationship with HDL (β = .012, p = .021) whereas the number of individuals living in the home had a statistically significant relationship with HDL (β = .026, p < .000) and BMI (β = .046, p = .02). In addition, 15% of participants reported being food insecure.

Discussion:

Efforts are needed to identify and screen at-risk populations living in geographically isolated areas. Considerations should be given to leveraging existing community resources for grandparent caregivers via schools, health systems, and government agencies to optimize health and well-being.