bluuebunny/crossref_metadata_2025 huggingface dataset:
Criminal liability and epilepsy: a case report of a postictal attempted homicide from Tunisia
Authors: Omri Sana , Smaoui Najeh , Feki Rim , Gassara Imen , Zouari Lobna , Ben Thabet Jihene , Maalej Mohamed , Maalej Bouali Manel , Charfi Nada
Published: March 2023

Objective

Patients with epilepsy who have been charged with a serious offense may be referred by the courts for forensic psychiatric examination. A detailed psychiatric and neurological examination is often necessary to assist the courts in making the right decision, as exemplified in the current case presentation.

Method

The forensic case of a 30-year-old Tunisian male with temporal epilepsy who exhibited an inadequate response to the treatment is presented here. The patient attempted to kill his neighbor after a cluster of seizures, showing apparent postictal aggression. An antiepileptic treatment was introduced a few days after the person’s detention and was followed by forensic psychiatric examination, but the latter was not done until three months afterwards.

Results

On forensic examination, the patient’s thought processes were clear with no evidence of a thought disorder or psychosis. Both medical and psychiatric opinions stated that the attempted homicide was due to a postictal psychosis. The patient was transferred to a psychiatric facility for further management and was found not guilty by reason of insanity.

Conclusion

This case illustrates the difficulties that experts may encounter in establishing criminal liability after aggressive behavior associated with epilepsy. It highlights shortcomings in Tunisian law (and promptness of forensic psychiatric examination) that should be addressed to ensure fairness of the legal process.
Comparison of methods for determining the gel content in natural rubber and the effect of gel content on rheological behavior
Authors: Čadek Drahomír , Šimek Jan , Foitlová Agáta , Kadeřábková Alena , Hrdlička Zdeněk , Cai Zhejing , Kuta Antonín
Published: March 2023

Natural rubber, given its natural origin, is not composed exclusively of polyisoprene chains, but also of so-called non-rubber components such as proteins or phospholipids. Such compounds are responsible for gel formation - insoluble phase if natural rubber (NR) is in a proper solvent. Gel is one of the causes why the behavior of NR is non-standard during processing. The gel content is determined by various methods, while it is not examined in detail which method has a stronger relation to the rheological behavior of rubber. Three different methods (filtration, dissolution in toluene for three different times and Soxhlet extraction) used for determining the gel content of NR are compared in this paper. Analytical (ash content, molar mass measurement, …) and rheological (Mooney viscosity, rubber process analyzer measurements, …) measurements are performed and their results are correlated with the gel content values.
Anonymous security authentication protocol based on identity encryption for cyber–physical power system
Authors: Li Xue , Chen Jiale , Jiang Cheng , Du Dajun , Zhu Yongsheng
Published: March 2023

With the rapid development of wireless technology, the deep coupling of cyber–physical power system (CPPS) is accelerated, and the openness of communication network makes the importance of secure information transmission increasingly prominent. As the communication module of CPPS, smart devices play an important role in data transmission, to ensure reliable and confident communication between the two layers. This paper presents a design for a secure and efficient smart devices utilizing anonymous security authentication and negotiation protocol supported by the identity-based cryptograph, elliptic curve cryptography, and digital signature algorithm are mainly used for that purpose. The security of the protocol is proved and validated under the random oracle model. The analysis show that the protocol has security performance such as bidirectional authentication, privacy protection, and replay attacks resistance; moreover, it has less computation and communication cost.
Fully distributed leader–follower consensus for multi-agent systems based on reduced-order adaptive feedback protocol
Authors: Liu Xianping , Song Jinbao , Zhang Xuxi
Published: March 2023

This paper addresses the leader–follower consensus problem of linear multi-agent systems by designing reduced-order adaptive output feedback protocol. Using relative output information among neighboring agents, node-based adaptive output feedback control protocol and edge-based adaptive output feedback control protocol are presented, respectively. For both cases, based on Lyapunov analysis and algebraic Riccati equation design, some sufficient conditions are given to achieve leader–follower consensus by applying the proposed adaptive output feedback protocols. Finally, some simulation examples are given to illustrate the validity of the theoretical results.
Adaptive neural network sliding mode control for reliable stabilization of uncertain Takagi–Sugeno fuzzy systems regulated by switching rules
Authors: Jiang Baoping , Chen Shouzhuan , Karimi Hamid Reza , Li Bo
Published: March 2023

The problem of adaptive sliding mode control for a class of continuous-time Takagi–Sugeno fuzzy systems regulated by the event of switching rules relying on neural network estimation method is put forward in this paper, where the plant suffers from state delay, internal structure uncertainty, and unknown nonlinearity. By proposing a switching surface in integral type, it obtains a sliding motion with desired property. In addition, to compensate the plant unknown nonlinearity and to meet the reaching condition, a radial basis function neural-network-based adaptive law is designed to ensure the existence of sliding motion in finite time. Furthermore, for the purpose of exponential stabilization of the sliding motion, a linear matrix inequality condition accompanied with switching signal characterized by an average dwell time is put forward. Finally, two numerical examples, one with all subsystems unstable and the other with stable subsystems and unstable systems, are shown to confirm the validity.
Employee Incentives and Family Firm Innovation: A Configurational Approach
Authors: Villani Elisa , Linder Christian , De Massis Alfredo , Eddleston Kimberly A.
Published: March 2023

According to family business theory and practice, family firms often face a paradoxical tension between their anchorage to the past and the need to renew and innovate to remain competitive, which often hampers innovation. Given that innovation is inherently a social process that depends on the knowledge and creativity of an organization’s people, employee incentives may be key to managing the tradition–innovation paradox and unlocking a family firm's innovation potential. However, current research has not addressed how family firms can effectively configure incentives to promote innovation. Drawing on a configurational approach and the unique properties of the qualitative comparative analysis method, our study reveals that the set of incentives that family firms use to motivate their employees toward innovation differs in relation to whether they are more or less attached to tradition. As such, in line with the principle of equifinality, family firms with high attachment to tradition can be as innovative as those with low attachment to tradition by implementing the right configuration of incentives. Thus, we offer a human resource management perspective on innovation that advances knowledge on how family firms can unlock their innovation potential.
County Immigration Enforcement in the Context of Unsettled Federalism: From Obama to Trump
Authors: Reich Gary M. , Scott Michael C.
Published: March 2023

We examine patterns of county participation in immigration enforcement across the Obama and Trump administrations and responses to the Trump administration’s efforts to mandate local compliance with Immigration and Customs Enforcement (ICE) directives. We focus on the policy that directly speaks to local discretion in enforcing federal law—namely, the willingness of local officials to render immigrant detainees to ICE. We find that underlying patterns of detainee transfers from counties to ICE were largely consistent between the Obama and Trump administrations. Nonetheless, the rate of detainee transfers increased during the Trump administration, an outcome associated with county support for Trump in the 2016 election. The findings suggest that partisanship is an entrenched source of diverging county enforcement practices, increasing intergovernmental conflict and undermining the “steam valve” potential of immigration federalism.
Is this dyspnea because of coronary artery disease? A rare case report of primary neuroendocrine tumor in anterior mediastinum
Authors: Rumbinaitė Eglė , Dirsienė Rūta , Vaitiekus Domas , Poškienė Lina , Žūkaitė Gabrielė , Stankevičienė Šarūnė , Šakalytė Gintarė , Dobilienė Olivija , Benetis Rimantas
Published: March 2023

Introduction

Mediastinal neuroendocrine tumors are rare malignancies with aggressive behavior and a grim prognosis. These malignancies often go undetected until they are diagnosed at advanced stages.

Case report

We present the case of 74 -years old man who was hospitalized because of non-ST elevation myocardial infarction and in case of three vessels coronary artery disease, coronary bypass surgery was planned. During preoperative investigation, computer tomography revealed a huge tumor (20 cm × 11 cm × 21 cm in size) in the anterior mediastinum. Successful simultaneous operation coronary bypass surgery and removal of the mediastinal tumor was performed.

Discussion

Surgery is the treatment of choice for neuroendocrine tumors but the relapse rate ranges between 5% and 30% and is higher (65%) in atypical neuroendocrine tumors and patients with mediastinal node involvement. Despite the poor prognosis of neuroendocrine tumors, the spread to the lymph nodes, the patient continues chemotherapy treatment 49 months after the operation.
Custodiol cardioplegia for temporary mechanical circulatory support
Authors: Tennyson Charlene , Grant Stuart , Chow Bobby HN , Sarsam Mazin AI , Kadir Isaac , Dimarakis Ioannis
Published: March 2023

Several patients requiring biventricular mechanical circulatory support in the acute setting will not be candidates for less invasive advanced heart failure therapies not requiring median sternotomy. Temporary biventricular assist device may provide reliable short term support bridging patients to recovery or further advanced treatments. However, this exposes patients to increased risk of reoperation due to bleeding and further exposure to blood products. This article outlines the practical details necessary in performing this technique while minimizing potential complications.
Acute myeloid leukemia: Incidence, transplantation and survival through Italian administrative healthcare data
Authors: Calabria Silvia , Ronconi Giulia , Dondi Letizia , Piccinni Carlo , Pedrini Antonella , Esposito Immacolata , Addesi Alice , Rossi Giuseppe , Ferrara Felicetto , Venditti Adriano , Martini Nello
Published: March 2023

Objective:

To identify newly diagnosed patients with acute myeloid leukemia in 2017 treated with intensive chemotherapy or unfit for intensive chemotherapy, and to assess their probability of receiving allogeneic stem cell transplantation and survival, from the Italian National Health Service perspective.

Patients and methods:

From the Ricerca e Salute database, adults with an in-hospital diagnosis of acute myeloid leukemia (International Classification of Disease-9th version-Clinical Modification code 205.0x) in 2017 (index date), without any identifying acute myeloid leukemia criteria within the preceding year, were selected. Among them, subjects treated with intensive chemotherapy (chemotherapy during an overnight hospitalization) within one year after index date were identified. The remaining were considered unfit for intensive chemotherapy. Gender, age and comorbidities were described. Within the follow-up period, probabilities of in-hospital allogeneic stem cell transplantation and overall survival were assessed through Kaplan Meier analyses.

Results:

From 4,840,063 beneficiaries of the Italian National Health Service, 368 newly acute myeloid leukemia diagnosed adults (9.0 *100,000) were selected. Males comprised 57%. Mean age was 68±15. There were 197 patients treated with intensive chemotherapy. The remaining 171 unfit for intensive chemotherapy were older (72±14) and with more comorbidities (e.g. hypertension, chronic lung diseases and chronic kidney disease). Only patients treated with intensive chemotherapy underwent an allogeneic stem cell transplantation (41; 33%) during the one year after the index date. Within the first and second follow-up year, respectively: 41.1% and 26.9% of subjects treated with intensive chemotherapy (144) survived (median survival time: 7.8 months); 25.7% and 18.7% of those unfit for intensive chemotherapy (139) survived (1.2 months). Difference was significant (p<0.0001). Within one and two years after transplantation (41 patients), 73.5% and 67.3% of subjects survived, respectively.

Conclusion:

This study, by showing the incidence of acute myeloid leukemia in Italy in 2017, the proportion of patients treated with intensive chemotherapy from the new diagnosis, the use of allogeneic stem cell transplantation and two-year survival, integrated evidence on large and unselected populations and may help to improve treatment strategies of older acute myeloid leukemia patients.
A Moderated Mediation Analysis to Further Examine the Role of Verbal Intelligence in the Association Between Psychopathic Personality and Crime
Authors: Etzler Sonja , Rettenberger Martin , Rohrmann Sonja
Published: March 2023

The current study examined the association between psychopathy, criminal behavior, and the role of verbal intelligence. One promising approach is to examine alternative links between psychopathic traits and criminality like moderation and mediation effects by considering the potential relevance of verbal intelligence as a possible moderating variable. We hypothesized that psychopathic traits linearly predict antisocial behavior (ASB) but that a conviction because of ASB is moderated by verbal intelligence. To test a path model of this hypothesis, N = 305 participants (42% women; n = 172 inmates of German correctional facilities) filled in questionnaires to assess psychopathic traits, ASB, criminal behavior, and verbal intelligence. The moderated mediation analysis revealed that high psychopathic traits go along with a higher number of ASB, whereas individuals with higher verbal intelligence were more likely to evade detection, thus being more successful in their antisocial acts. These results sheds further light on the construct of adaptive psychopathy, supporting the notion that also non-incarcerated psychopathic individuals act highly antisocial. Only separate factors like verbal intelligence might mitigate negative consequences. Further implications for the concept of successful psychopathy are discussed.
Individual Characteristics and Organizational Attributes: An Assessment of Probation Officer Burnout and Turnover Intent
Authors: Alward Lucas M. , Viglione Jill
Published: March 2023

In recent years, Western and non-Western countries have experience increased reliance on probation services. However, prior research indicates that high job demands and ambiguous role responsibilities invoke feelings of stress and suggest the importance of understanding the relationship between stress and burnout and turnover. While past efforts largely focused on correctional officers (COs), less is known about how probation officers (POs) experience burnout and how organizational attributes may influence this relationship. Using survey data of federal POs ( N = 80) across eight offices in a southern state, the current study examines the influence of individual characteristics and organizational attributes in predicting burnout and turnover intent. To answer our research questions, we perform a series of linear regression models. Findings suggest the importance of affective commitment for reducing POs’ feelings of burnout and turnover intent. Implications of these findings and directions of future research are discussed.
Internal Focalization in 1 Samuel – a new perspective on Jonathan’s love for David
Authors: Hakvoort Richard G.
Published: March 2023

The narratological instrument of internal focalization offers a hitherto unexplored perspective on the narratives in 1 Samuel, in general, and on the Jonathan narratives, in particular. Internal focalization means that, in the narrative, the viewpoint of a character in the story is chosen, though not necessarily that of the main character. It appears that in contrast to most of the Old Testament (OT) prose, the book of 1 Samuel is abundant in the varying use of internal focalization. Applied to the David-Jonathan narratives, it is Jonathan who is the internal focalizer. This means we read about Jonathan’s thoughts, emotions, and perceptions instead of David’s. David, however, acts as focalized object, which means the focus of attention of the internal focalizer (Jonathan) is on David. This new perspective on the David-Jonathan narratives leads to fresh insights into the issue of the seemingly one-sided love of Jonathan for David. This may very well be explained by the fact that Jonathan is the internal focalizer. Hence, we read about his feelings for David. It does not necessarily mean that David has no similar feelings for Jonathan, but the narrator simply does not highlight these.
Enhanced Pavement Design and Analysis Framework to Improve the Resiliency of Flexible Airfield Pavements
Authors: Barbi Paula Sutherland Rolim , Tavassoti Pejoohan , Tighe Susan
Published: March 2023

Changes in climatic conditions can directly affect pavement performance. However, accounting for environmental factors in airport pavement design remains a challenge since design methods such as FAA rigid and flexible iterative elastic layered design (FAARFIELD) do not consider moisture and temperature variation as input. Therefore, to address this research gap and improve the resilience of airport pavements, this research proposes a new methodology for the structural design of flexible airport pavements. The proposed methodology in this research was applied to a case study of an international airport in Canada, using actual field data. Five scenarios were evaluated including the current climate, temperature increase, lower matric suction, and two flooding events. The results of the proposed design method showed that the traditional FAARFIELD analysis can possibly overestimate fatigue damage, and underestimate rutting damage. The outcomes showed that climate change can increase pavement damage and shorten the service life from 7 to 14 years in the scenarios evaluated. It was also concluded that the lowering of the matric suction can result in the highest damage levels. Considering the implications of climate change on transportation infrastructure, the proposed methodology can contribute to designing more resilient airport pavements in the future, since it accounts for climate variations, temperature, and moisture changes, as well as extreme events such as flooding over the design life of flexible airport pavements.
Making Communities Age-Friendly: Lessons From Implemented Programs
Authors: Forsyth Ann , Lyu Yingying
Published: March 2023

A growing number of programs promoted by planners and others have aimed to foster communities that support older people. Do such programs make a substantial difference? Through a scoping review of research evaluating WHO-style age-friendly community initiatives (AFCIs), we investigate what kind of outcomes such initiatives have achieved and factors facilitating or hindering them. Elements affecting implementation varied by geographies. They included external resources (e.g., government support, funding, consultants), local resources (e.g., community size, demographics, staff, infrastructure), engaged local participants (e.g., partnerships, champions, older people), and effective strategies to build support (e.g., quick wins, awareness building, cultural sensitivity).
Helping Mom Die: An Auto-ethnographic Account of Preparing for Death
Authors: Wysocki Diane Kholos
Published: March 2023

This article is about a journey that I took with my mother as she left us. It is an article using an autoethnographic approach which allows me, the writer, to use both my personal pain and thoughts as a way to give peace, understanding, and perspective of the time before my mom’s death. This article is also about giving a framework for those who will also go through the same experience with an aging parent, to both take away the stigma of death and to help the reader be present in a tough situation. For me, it was an honor to be with the woman who brought me into this world and to be able to be alone with her as she left.
The Impact of New Jersey's Urban Enterprise Zones on Local Employment: A Synthetic Control Approach
Authors: Scavette Adam
Published: March 2023

The designation of enterprise zones is a place-based policy that seeks to revitalize economically blighted areas. The literature on place-based policies has found mixed results regarding their effects on local payroll employment. This paper examines the causal effects of five of New Jersey's Urban Enterprise Zones (UEZs) on local payroll employment: Bayonne, Gloucester City, New Brunswick, Roselle Borough, and The Wildwoods (Wildwood City, Wildwood Crest, North Wildwood, and West Wildwood). All were designated as UEZs by the state in the 2000s, and none have been previously evaluated in the academic literature. The program offers reduced local sales tax, tax credits for newly hired employees, subsidized unemployment insurance costs, worker training assistance, and tax-free purchases on capital equipment and facilities. A synthetic control approach is used with the industrial composition of local firms and poverty rate as the covariate group and no impact of UEZ status on local employment in the treatment periods of the five areas is found. These results suggest that enterprise zones may not be effective job creators for treated areas, particularly for those zones that were added long after the program's inception.
Surface integrity of Ti-6Al-4V alloy in hybrid electrical discharge machining processes
Authors: Khosrozadeh Behnam
Published: March 2023

Titanium alloy is one of the difficult-to-machine materials. The final conditions of the machined surface of this alloy are influenced by electro-discharge machining. High temperatures and thermal cycles in machining operation induce undesirable alterations in the surface quality of Ti-6Al-4V. One of the ways to improve the negative effects of electrical discharge machining is to use hybrid methods. There is no comprehensive research on the effect of hybrid electrical discharge machining process on the surface integrity of the Ti-6Al-4V alloy. In this paper, hybrid electrical discharge machining techniques including ultrasonic-assisted electrical discharge machining, powder-mixed dielectric electrical discharge machining using Al2O3 nanopowders and powder-mixed dielectric combined with ultrasonic-assisted electrical discharge machining, were used for processing of this alloy. The hybrid electrical discharge machining processes were evaluated by basic specifications of surface integrity including surface cracks, heat affected area, residual stress, and corrosion resistance. It was found that in powder-mixed dielectric combined with ultrasonic-assisted electrical discharge machining process, developed microcracks were very low and this process developed a thinner heat-altered layer, compared to traditional electrical discharge machining process, which produced a thicker heat-altered layer. The findings also, demonstrated that ultrasonic waves have reduced residual stresses compared to other methods and its stress diagram was distinct in comparison with the other processes. The corrosion rate of samples machined by electrical discharge machining process was higher than other hybrid processes; in powder-mixed dielectric electrical discharge machining process, the machined samples had the highest corrosion resistance.
Feasibility analysis of robot-assisted processes for automated tolerance compensation by using additive manufacturing
Authors: Fiedler Maximilian , Meyer Hagen , Fischer Fabian , Droeder Klaus
Published: March 2023

By using direct joining presses in combination with thermal material extrusion processes, individually adapted spacers made of polyethylene terephthalate which is prepared with glycol can be applied to conventionally manufactured components made of acrylonitrile-butadiene-styrene copolymer in order to automatically compensate bigger deviations. In this study, a prototype system, especially built for this application was developed to analyze a flexible compensation method for deviated parts, made by injection moulding. By using a KUKA robot, the freedoms of movement are increased compared to a cartesian system. The main objective by using this method is, to investigate the dimensional accuracy of the applied samples and the required production time. Selected process modifications are used to further optimize the dimensional accuracy and production time. The evaluation and assessment of the applied samples is performed by using a line scanner. The results suggest that manufacturing processes can be made more accurate and cost effective.
Investigation on NO reduction behavior within complex atmosphere during pilot ignition of low calorific gas
Authors: Du Yongbo , Xing Meng , Zhang Jingkun , Deng Lei , Che Defu
Published: March 2023

Low calorific gas (LCG) is largely produced in industries and agricultures, but its utilization is difficult due to the poor combustibility and high NO x emission. The pilot ignition combustion has the potential to improve LCG’s combustibility and also reduce NO production with combining air stage approach. However, the complex atmosphere created under pilot ignition condition could complicate the NO reduction (by CH4) behavior and should be clarified. This paper is aimed at gain a deep insight on this issue by exploring the interaction between temperature and atmosphere, the individual role of α and CH4 concentration (or its ratio to NO), and the influence of CO and CO2 presence. The results show that with dropping α, the maximum NO reduction ratio increases, but a higher temperature is needed to achieve this value. Under fuel rich condition, NO reduction was accompanied with HCN formation, which must be considered to analyze the effective reduction. The CO2 generated from pilot flame or originally contained in LCG could inhibit the NO reduction, with this effect being more pronounced at a fuel rich atmosphere. For a CO/CH4 duel reactive LCGs, CO reduces the NO reduction ratio at lower temperature, but improves at higher temperature.
Super, social, medical: Person-first and identity-first representations of disabled people in Australian newspapers, 2000–2019
Authors: Potts Amanda , Bednarek Monika A , Watharow Annmaree
Published: March 2023

This paper provides an interdisciplinary, corpus-based study of naming practices for disabled people in a collection of Australian newspaper articles spanning 20 years. We analyse head nouns, modifiers, and coordinating structures for both person-first and identity-first language, drawing on social actor analysis as well as previously-identified models of media representation. Overall, we find similar usage of both naming practices with respect to the types of social actors that occur, the categorisations of disabilities that are referenced, and the associations that are established, with only minor differences. Additionally, both naming practices are strongly associated with the medical and social pathology models of media representation, which emphasise disadvantage, with almost a total absence of ‘progressive’ models, which represent people as multifaceted agents. We conclude by emphasising the need for the news media to incorporate the voices and preferences of disabled people themselves.
A new city's water–energy nexus implications: The case of Sejong City in South Korea
Authors: Yoo Jae-Ho , Kim Hana
Published: March 2023

Cities’ impact on water, energy, and greenhouse gas (GHG) emissions is increasing as the world becomes more urbanized. Focusing on Sejong City, which was developed as a new administrative hub in South Korea in 2012, this study scrutinizes its development path from water–energy nexus perspective by developing a system dynamics model that describes the interactions among numerous components related to water and water-related energy consumptions. Furthermore, this study reimagines the city's potential development trajectories by constructing nine policy scenarios that combine different degrees of water conservation ambitions with different amounts of decarbonization in the power sector. The results confirmed the potential of water conservation policies. The expansion of rainwater use has the potential to cut water use by 50% from the 2050 baseline levels. Although the use of harvested rainwater is negligible compared to wastewater reuse, its overall effect on water conservation would be substantial if it is increased. The maximum reduction in GHG emissions from the water sector would be 9.36% from the 2050 baseline scenario when combined with decarbonizing the power sector. Although this study does not fully account for the water conservation potential, including the efforts at the end-use stages, the possibility of carbon neutrality in Sejong's water sector by 2050 is presented. It affirms that local governments can significantly reduce cities’ environmental footprints and complement national efforts for the transition to a carbon-neutral society.
End-Of-Life Care Planning and Bereavement Practices Among Adult Day Services Centers, 2018
Authors: Lendon Jessica P. , Caffrey Christine , Lau Denys T.
Published: March 2023

Introduction: This study describes the end-of-life (EOL) care planning and bereavement practices among adult day services centers (ADSC) when an ADSC participant is dying or has died. Methods: Data are from the 2018 National Study of Long-term Care Providers’ biennial survey of ADSCs. Respondents were asked about the following 4 practices: 1) honoring the deceased in some public way in this center; 2) offering bereavement services to staff and participants; 3) documenting in the care plan what is important to the individual at the end of life (EOL), such as the presence of family or religious or cultural practices; and 4) discussing spiritual needs at care planning conferences. ADSC characteristics included US Census region, metropolitan statistical area status, Medicaid authorization, electronic health records (EHR) use, for-profit status, employment of aides, services provision, and model type. Results: About 50% to 30% of ADSCs offered the EOL care planning or bereavement services. Honoring the deceased was the most common practice (53%), followed by bereavement services (37%), discussing spiritual needs (29%), and documenting what is important at EOL (28%). Fewer ADSCs in the West had EOL practices relative to the other regions. The EOL planning and bereavement practices were offered more often in ADSCs that used EHRs, accepted Medicaid, employed an aide, provided nursing, hospice, and palliative care services, and were categorized as medical models, compared with ADSCs without these characteristics. Conclusion: These results highlight the importance of understanding how ADSCs provide EOL and bereavement care to participants who are near EOL.
Reflective Foreign Bodies Mimicking Fistulae of the Hard Palate in the Paediatric Population
Authors: Martin Serena , Thorburn Terence Guy , Swan Marc Christopher
Published: March 2023

Palatal foreign bodies remain relatively rare, consequently, delays in diagnosis and misdiagnosis can occur leading to unnecessary anxiety and invasive investigations. We report three children with a reflective disc from inside a confetti balloon masquerading as a fistula of the hard palate. Awareness of this foreign body phenomenon enabled timely diagnosis in subsequent patients; hence the need to highlight such cases to the global cleft community. Crucially, while the foreign body remains in the oral cavity, there is an ongoing risk of airway aspiration which could be life threatening. Removal can be easily facilitated in the outpatient setting.
Lung Cancer Screening Knowledge in Four Internal Medicine Programs
Authors: Urrutia Argueta Samuel , Basnet Nishraj , Abdul-Kafi Owais , Hanna Nasser
Published: March 2023

Introduction

Lung cancer remains the leading cause of cancer-related death in the United States. Low density CT (LDCT) has been shown to reduce mortality in high-risk populations. Recognizing and mitigating gaps in knowledge in early medical training could result in increased utilization of screening CT in high risk-populations.

Methods

An electronic survey was conducted among Internal Medicine (IM) residents at 4 academic programs in the Midwestern United States. A survey was distributed to evaluate knowledge about high-risk populations, mortality benefits, and a comparison in mortality benefits between LDCT and other screening modalities using number needed to screen (NNS). Results: There was a 46.6% (166/360) response rate. Residents correctly answered an average of 2.9/7 (43.1%) questions. PGY-1 (post-graduate year) and PGY-2 residents performed better than PGY-3 (P = .022). Only 1/3 rd of all respondents correctly identified the population needed to be screened. Over 80% of residents thought screening with LDCT had a cancer-specific mortality benefit but were evenly split (except Program 2 residents), on recognizing an all-cause mortality benefit with LDCT, (P = .016). Only 7.7% thought women benefited the most from LDCT. Self-assess and attained knowledge were similar among programs.

Conclusions

LDCT is a noninvasive intervention with a substantial mortality reduction, especially in states with high rates of smoking, and is widely covered by insurers. With average knowledge score less than 50%, this study shows there is a substantial need to increase the knowledge of LCS in IM residency programs.
The role of the pharmacist in the hospital discharge of cancer patients: an integrative review
Authors: Mattos Luciana Favoreto Vieira , de Sousa Ana Rosa Navegantes , Teixeira Jéssica Fernanda , Costa Mariana Fernandes , de Castilho Selma Rodrigues
Published: March 2023

Introduction

Patients with cancer need care from a multidisciplinary team due to the complexity of the clinical picture and proposed treatment. Hospital discharge is a critical step, because pharmacotherapy changes may occur during hospitalization, leading to potential medication-related problems at home.

Objective

To identify publications which describe the activities performed by the pharmacist at the hospital discharge of patients with cancer.

Method

This is an integrative systematic literature review. A search was carried out in the MEDLINE databases, via Pubmed, Embase, and Virtual Health Library, using the following descriptors: “Patient Discharge”, “Pharmacists”, “Neoplasms.” Studies that reported activities performed by the pharmacist at the hospital discharge of patients with cancer were included.

Results

Five hundred and two studies were identified, of which seven met the eligibility criteria. Most were conducted in the United States (n = 3), and the rest in Belgium, Brazil, Canada, and Italy. Among the services provided by the pharmacist at discharge, medication reconciliation was the most widely described. Other activities such as counseling, education, identification, and resolution of drug-related problems were also carried out.

Conclusion

In the scenario of hospital discharge of patients with cancer, the participation of pharmacists is still to be seen as of significance in regards to publications. Despite this, the results suggest that the actions of this professional contribute to patient orientation and the safe use of prescription drugs for use at home.
A Grounded Theory Model of Relationship Decision-Making in Non-Offending Partners of Individuals Accused of Sexual Offending
Authors: Kamitz Lea C. , Gannon Theresa A.
Published: March 2023

Non-offending partners of individuals who have committed sexual offenses often choose to end their relationship given the many negative consequences they face as a result of their partner’s offending behavior. Despite a focus on relationships in rehabilitation frameworks and the importance of the relationship for the individual who has offended and their partner, research has thus far failed to examine the process underlying why non-offending partners decide to stay in or leave their relationship following an offense. In this study we developed the first descriptive model of relationship decision-making in non-offending partners. Twenty-three individuals whose current or previous partners were accused of sexual offending were interviewed about affective, behavioral, cognitive, and contextual factors contributing to their decision to stay with or leave their partner. Participants’ narrative accounts were analyzed using Grounded Theory. Our resulting model consists of four main periods: (1) background factors, (2) relationship factors, (3) finding out, and (4) relationship decision-making. Clinical implications, limitations, and directions for future research are discussed.
Effects of ultrasound with an automatic vessel detection system using artificial intelligence on the selection of puncture points among ultrasound beginner clinical nurses
Authors: Abe-Doi Mari , Murayama Ryoko , Takahashi Toshiaki , Matsumoto Masaru , Tamai Nao , Nakagami Gojiro , Sanada Hiromi
Published: March 2023

Background:

Ultrasound guidance increases the success rate of peripheral intravenous catheter placement. However, the longer time required to obtain ultrasound-guided access poses difficulties for ultrasound beginners. Notably, interpretation of ultrasonographic images is considered as one of the main reasons of difficulty in using ultrasound for catheter placement. Therefore, an automatic vessel detection system (AVDS) using artificial intelligence was developed. This study aimed to investigate the effectiveness of AVDS for ultrasound beginners in selecting puncture points and determine suitable users for this system.

Methods:

In this crossover experiment involving the use of ultrasound with and without AVDS, we enrolled 10 clinical nurses, including 5 with some experience in peripheral intravenous catheterization using ultrasound-aided methods (categorized as ultrasound beginners) and 5 with no experience in ultrasound and less experience in peripheral intravenous catheterization using conventional methods (categorized as inexperienced). These participants chose two puncture points (those with the largest and second largest diameter) as ideal in each forearm of a healthy volunteer. The results of this study were the time required for the selection of puncture points and the vein diameter of the selected points.

Results:

Among ultrasound beginners, the time required for puncture point selection in the right forearm second candidate vein with a small diameter (<3 mm) was significantly shorter when using ultrasound with AVDS than when using it without AVDS (mean, 87 vs 247 s). Among inexperienced nurses, no significant difference in the time required for all puncture point selections was found between the use of ultrasound with and without AVDS. In the vein diameter, significant difference was shown only in the absolute difference at left second candidate among inexperienced participants.

Conclusion:

Ultrasonography beginners needed less time to select the puncture points in a small diameter vein using ultrasound with AVDS than without AVDS.
Hemodialysis vascular access in prone position for critically ill patients with ARDS
Authors: Marcos García Nava , Daniel Mauricio Vallejo Rocha , Lillana Pacchiano Alemán , Maria Rodríguez Armida , Griscelda Hernández Morales , Iván Armando Osuna Padilla , Jesús Arturo Rivero Martínez
Published: March 2023

Introduction:

Acute respiratory distress syndrome (ARDS) is defined in critically ill patients with acute hypoxemia and positive-pressure ventilation in association with several clinical disorders including trauma, pneumonia, sepsis, and aspiration. The prone position has been used for many years and is now recommended for patients with severe or moderate-to-severe ARDS on invasive mechanical ventilation. Acute kidney injury (AKI) is a common complication in patients with ARDS, with up to a 35% incidence rate. Initiation of Kidney Replacement Therapy (KRT) requires wise clinical judgment and collaboration between nephrologists and intensivists. A properly functioning vascular access is critical for an optimized KRT. Our institute is a national referral center for respiratory diseases.

Results:

We describe 11 cases of dialysis catheter placement for KRT in critically ill patients with ARDS on mechanical ventilation in prone position. The catheter was placed in the first puncture attempt in nine cases, Blood flows (Qb) achieved were 283.4 ± 20.4 ml/min during the session, in six cases the radiologic tip location was achieved in the peri cavoatrial junction; in four cases was achieved in mid to- deep right atrium. The dialysis quality standards were based on KTV and in URR; in nine cases (81.81%) KTV was in 1.3 and in all cases (100%) URR was >65%, lumen dysfunction was reported only in two cases (18.1%), but these cases did respond to mobilization maneuvers. The procedure time of placement was 29.8 min, no arterial punctures or complications were reported.

Conclusions:

We demonstrate that in our study hemodialysis non-tunneled catheter placement in the prone position is safe and effective. We believe this practice could be frequently used in the near future and represent an opportunity window for the training of interventional nephrologists and related areas.
Treatment-related early discontinuations and adverse events among newly diagnosed people living with HIV initiating integrase inhibitors in a real-world setting
Authors: Rolle Charlotte-Paige , Castano Jamie , Nguyen Vu , Patel Kiran , Hinestrosa Federico , DeJesus Edwin
Published: March 2023

Background

Cohort studies suggest higher discontinuation rates with integrase strand transfer inhibitors (INSTIs) than are seen in clinical trials. We assessed discontinuations and adverse events (AEs) that were considered related to the initial INSTI in the first year following initiation among treatment-naïve people living with HIV (PLWH).

Methods

Newly diagnosed PLWH initiating raltegravir, elvitegravir/cobicistat, dolutegravir or bictegravir in combination with emtricitabine/tenofovir alafenamide or emtricitabine/tenofovir disoproxil fumarate between 10/2007 and 1/2020 at the Orlando Immunology Center were included. Unadjusted incidence rates (IRs) and incidence rate ratios (IRRs) were calculated for treatment-related discontinuations and AEs associated with the initial INSTI in the first year following initiation.

Results

Of 331 enrolled, 26 (8%) initiated raltegravir, 151 (46%) initiated elvitegravir/cobicistat, 74 (22%) initiated dolutegravir and 80 (24%) initiated bictegravir. Within the first year, treatment-related discontinuations occurred in 3 on elvitegravir/cobicistat (IR 0.02 per person-years (PPY)) and 5 on dolutegravir (IR 0.08 PPY); no treatment-related discontinuations occurred among those initiating raltegravir or bictegravir. Eleven treatment-related AEs occurred in 7 on raltegravir (IR 0.46 PPY), 100 treatment-related AEs occurred in 63 on elvitegravir/cobicistat (IR 0.72 PPY), 66 treatment-related AEs occurred in 37 on dolutegravir (IR 0.97 PPY) and 65 treatment-related AEs occurred in 34 on bictegravir (IR 0.88 PPY). Unadjusted IRRs did not reveal any significant difference between INSTIs in terms of early treatment-related discontinuations or AEs.

Conclusions

In our cohort, treatment-related AEs occurred in 43% initiating INSTIs but were responsible for early discontinuation in only 2% with no treatment-related discontinuations observed among those initiating RAL or BIC.
Constructing mediator identities through questioning in Chinese televised mediation
Authors: Zhang Xian , Dong Yanbiao
Published: March 2023

This study, integrating poststructuralist discourse analysis and conversation analysis, analyzes how the question-answer sequences construct mediators’ dynamic identities during Chinese televised mediation. The research shows that different mediators in the team tend to employ different types of questions at varying stages; that questions serve not only to elicit information but also to manage the multilateral talk, to make assertions, to persuade, and to construct different identities; that different mediators’ identities include the manager, the reality tester, the moral educator, the facilitator, and the entertainer. Instead of remaining neutral, they might step out of the neutralistic circle and adhere to the golden mean. The complex representation of these identities is deeply rooted in China’s cultural and socioeconomic background. This study provides a thorough understanding of the interplay between questioning and identity in institutional contexts and the mechanism of Chinese televised mediation.
What’s really in a frame? The case of public marriage proposals
Authors: Abdel-Raheem Ahmed
Published: March 2023

Using a small corpus of marriage proposal stories authored by British citizens, this paper aims to identify and make explicit seven defining parameters of frames (namely, default elements, default scenario, default context, default inference, default form, default argument, and instantiations) and explain and exemplify each.
Combined effect of fiber hybridization and matrix modification on mechanical properties of polymer composites
Authors: Demir Okan , Yar Adem , Eskizeybek Volkan , Avcı Ahmet
Published: March 2023

Glass/carbon fiber reinforced hybrid composites are great candidates for wind turbine blade manufacturers to make larger blades. Variation of stacking sequences ensures design freedom to the composite engineers to optimize the composite structure's mechanical performance. On the other hand, matrix modification of polymer composites with nanoparticles is also of interest to introduce multifunctional properties. This research aims to scrutinize the influence of simultaneous fiber hybridization and matrix modification on polymer composites’ tensile, flexural, and low-velocity impact properties. Hybrid glass/carbon epoxy composites and hybrid glass/carbon/multi-walled carbon nanotube (MWCNT) multiscale polymer composites of stacking sequences [GCGCGC]S, [CGCGCG]S, and [G6C6] were manufactured. Fiber hybridization dramatically improved tensile strength between 51% and 76% compared to glass fiber composite. Depending on the stacking sequence, the flexural strength of the hybrid composites was improved between 10% and 16% concerning carbon fiber composite. With the introduction of MWCNTs, a slight increase in the tensile strength for unsymmetrical hybrid composites by around 5% and decreases by 7% for symmetrical ones were observed. Similar behavior was seen for bending characteristics. Additionally, low-velocity impact tests showed that it is achievable to bring greater impact peak forces up to 70% for hybrid composites than carbon fiber epoxy composites. MWCNTs modification of the matrix restrained the impact damage propagation, as proved by C-scan analysis.