bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship Between Vitamin B-12 Levels and Attention in Children and Adolescents
Authors: Alkan Hatice Kocak , Kocak Elif Nur , Coskun Orhan , Çıvak Serpil Çars¸anbalı , Güleç Seda Geylani
Published: September 2024

Background and Aim:

Vitamin B-12 plays a role in normal growth and development in childhood and adolescence. In this study, the effect of vitamin B-12 on attention was investigated.

Method:

A total of 138 participants who were admitted to the pediatric clinic during a three-month period between June 15, 2021, and September 15, 2021, between the ages of 9 and 16 years, who had their vitamin B-12 levels measured and met the inclusion criteria of the study were included in our study. D2 Attention Test data were obtained from the participants.

Results:

While 24.5% of the group with low vitamin B-12 levels had pathology according to the D2 Attention Test, 5.9% of the control group had pathology according to the D2 Attention Test. The percentage of pathology in those with low vitamin B-12 levels was statistically significantly higher than in the group with normal B-12 levels.

Conclusion:

It was observed that the attention level of the group with vitamin B-12 deficiency was lower. In the follow-up of healthy children, it is recommended to pay attention to the research on vitamin B-12 values.
Reflection on the RANZCP position on the adverse effects of psychotherapy
Authors: Allison Stephen , Looi Jeffrey CL , Kisely Steve , Bastiampillai Tarun
Published: September 2024

Objective

In this perspective, we investigate how the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) position statement on psychotherapy takes the potential for adverse effects into account.

Conclusions

Psychotherapy has two critical outcomes – efficacy and adverse effects. Evidence-based psychotherapy is significantly more effective than care-as-usual for about one in 10 psychotherapy patients. However, a similar proportion also reports adverse effects. Despite this, the RANZCP position statement on psychotherapy focuses on efficacy with minimal discussion of the adverse effects. This is an oversight because psychiatrists have legal and ethical obligations to consider the adverse effects as well as the benefits of any treatment. We therefore reflect on the RANZCP’s six recommendations in light of the adverse effects of psychotherapy.
Intro to What? Interrogating Introduction to Music Education Courses
Authors: Shaw Ryan D. , Hill Stuart Chapman
Published: September 2024

In this article, we analyze a course type common to music education degree plans: the “introduction to music education” (IME) course. Known as “intro to music ed” or by a variety of other names related to “foundations” and foundational thinking, this course type is ubiquitous. However, the aims, content, and possibilities are rarely interrogated. We first situate IME courses in broader discourses around teacher preparation and then discuss historical developments around IME coursework in music teacher education. Next, we describe empirical findings related to IME courses. Then, we discuss curricular options for IME and make specific recommendations for how IME courses accommodate progressive concerns of the field related to teacher socialization, philosophy and sociology, and diversity, equity, inclusion, and belonging (DEIB).
Effects of Prolonged Proton-Pump Inhibitor Use on Renal Dysfunction and Bone Fragility: A Retrospective Study
Authors: Protopapadakis Yianni , Shuster Hayden , Bambach Austin B. , Fitzgerald Sean , Brayman Christian , Ewing Joseph A. , Blumer Mary
Published: September 2024

Background:

Proton-pump inhibitor (PPI) use for management of gastroesophageal reflux disease (GERD) consists of a short-duration trial, according to guidelines. Long-term usage is appropriate under certain indications. Literature has increasingly documented an adverse effect profile of PPIs, including kidney disease and bone fragility.

Objective:

To investigate the rate of occurrence of osteopenia, osteoporosis, and chronic kidney disease (CKD) in patients using PPI therapy for longer than the recommended trial period of 8 weeks.

Methods:

Retrospective cohort analysis of a single-site primary care clinic. Patients aged 18 to 65 years with PPI prescriptions longer than 8 weeks were included. Information regarding PPI prescriptions, demographics, and medical diagnoses was collected.

Results:

The search discovered 293 PPI-users and 1908 never-PPI-users. Demographics varied, with a P-value <0.05 in age, body mass index (BMI), and black population (higher in PPI group). The PPI cohort featured higher rates of osteoporosis/osteopenia and CKD ( P < 0.001). The odds ratios (ORs) of diagnosis with PPI use was 2.91 (95% CI = [1.692, 4.979]) in osteoporosis/osteopenia. The OR was 1.14 (95% CI = [1.141, 2.229]) in CKD and PPI use but higher with diabetes, elevated BMI, black race, and male gender.

Conclusions and Relevance:

We observed increased occurrence rates of osteoporosis, or osteopenia, and CKD in patients with prolonged PPI use. Demographics varied in age, BMI, and black race proportion. A logistic regression revealed increased likelihood of kidney disease and osteoporosis/osteopenia in association with PPI use. These results add to the evidence regarding long-term PPI use and the development of these conditions, but additional studies are needed.
Sleep Science and the Limits of Creaturely Life: On Bonhoeffer and a Theology of Bodily Responsibility
Authors: Davidson Samuel
Published: September 2024

Reading Dietrich Bonhoeffer's theological anthropology in conjunction with Matthew Walker's monograph on the current state of sleep science ( Why We Sleep, 2017), the article explores how theological attention to sleep illuminates our relationships and responsibilities to God, world, self, and others. Sleep confronts us with our creaturely limits, and with the consequences of attempting to transcend them. These limits set us squarely within the world, situating us along a continuum with all animal life and reiterating the embodied nature of the human being. Sleep thus reminds us that the self is never separable from the body and its contexts, prompting questions about creaturely responsibility for the body/self in relation to God, as well as in relation to other human beings in whom we encounter our limits. Bonhoeffer's concept of creaturely limits is thus deployed and developed through attention to sleep, helping us name the interconnectedness of these relationships and responsibilities.
Predefined-time sliding mode filtering control of memristor-based Bao hyper-chaotic system
Authors: Zhu Shixiang , Li Rongfeng , Feng Yuming , Yan Dongfang , Oluwaseun Onasanya Babatunde
Published: September 2024

This paper extends the three-dimensional Bao system to the four-dimensional one by incorporating a smooth third-order nonlinear magnetic flux-controlled memristor as the feedback element. The four-dimensional Bao system is proved to be hyperchaotic and some of its dynamical characteristics are shown. The design of the system’s analog circuit is presented, and the results of circuit simulation aligns with numerical simulation ones. In addition, a predefined-time sliding mode filter controller is designed by employing an adaptive term to address the system’s unknown parameters to keep the system stable under external interference. Numerical simulation results demonstrate that the proposed controller exhibits faster convergence and less chattering compared to previous predefined-time sliding mode controller.
Optimal design of dynamic vibration absorber for elastic vibration control of vehicle carbody in time-varying service environment
Authors: Li Fansong , Du Xiang , Liu Letian , Wang Hao , Liu Chaotao , Wu Hao
Published: September 2024

Due to frequent acceleration and deceleration and large passenger capacity, metro vehicles generally experience eccentric wear on the wheels. Moreover, the highest running speed is between 80 km/h and 100 km/h, and the corresponding wheel rotation frequency is mainly between 7 Hz and 11 Hz, which is close to the first-order vertical bending modal frequency of the carbody. Therefore, the dynamic performance of the carbody would be deteriorated in the later stage of wheel wear. In order to suppress the vibration caused by eccentric wear, this study intends to design the underframe equipment as a dynamic vibration absorber. Unlike the traditional fixed-point theory method, this paper takes the external time-varying running speed as the input, a suspension frequency optimal design method based on probability distribution of wheel rotation frequency is proposed. And the design principle is experimentally verified based on the full-scale railway vehicle vibration test rig. Compared with the design method based on fixed-point theory, the results show that the acceleration rms value of carbody by optimal design method is reduced by 8% ∼ 20%. It is suggested that the design of underframe equipment for metro vehicles should be combined with the characteristics of time-varying service environment.
Design and verification of the square convex surface multilayer radar absorbing structure based on additive manufacturing
Authors: Jin Do-Hyeon , Park Dong-Jin , Lee Jung-Ryul , Ahn Joon-Mo
Published: September 2024

This paper presents a novel approach to addressing electromagnetic property variations in 3D printed structures using additive manufacturing (AM). Utilizing continuous fiber 3D printing, the focus is on designing and fabricating a square convex surface multilayer radar absorbing structure (RAS) tailored for obliquely incident electromagnetic (EM) waves. Variations in complex permittivity due to structural shape-influenced changes in nozzle paths in AM-fabricated 3D printed structures are observed. To counter this, a ‘Process Permittivity Correction Method’ is developed, enhancing design and fabrication accuracy. Before optimizing each structure of the RAS, the process permittivity, which varies according to the structural shape and the set nozzle paths, was applied in the design. The optimized RAS, considering both TE and TM modes at a 60° incident angle, showed a high correlation between the trends of interpreted and measured absorption performance. This approach effectively corrects electromagnetic property variations in 3D printed structures, ensuring consistency between design and manufacturing while maintaining EM properties and absorption performance.
The effectiveness of virtual versus human influencer marketing for tourism destinations
Authors: Hernández-Méndez Janet , Baute-Díaz Nisamar , Gutiérrez-Taño Desiderio
Published: September 2024

The organisations that manage tourism destinations are increasingly working with influencers in their promotional campaigns. Our research analyses how effective the promotion of a destination is according to the type of influencer: human or virtual. We used a design of experiments approach in which 954 participants from generations Y and Z looked at posts of tourism destinations created by the two types of influencers on Instagram. The results suggest that source credibility, parasocial interaction, attitude towards the post and attitude towards the destination are antecedents, direct or indirect, of intention to travel to the destination and to recommend it. The results show that both types of influencers are effective at promoting the destinations, although it was also confirmed that a human influencer is more effective at promoting a destination than a virtual one. Therefore, this study has practical implications for tourism organisations.
The Inverted Pyramid and Beyond: Perceptions of Distributive Justice Among (Highly) Qualified Workers in Contemporary Cuba
Authors: Jany Nina , Budowski Monica
Published: September 2024

In 2020/2021, wage scale reforms were implemented in Cuba to improve distributive justice. The previously long-prevailing wage system and resulting wage structure, often referred to as an inverted pyramid, is said to have especially affected (highly) qualified workers in Cuba. This research provides emergent and partly speculative data on perceptions of distributive justice that (highly) qualified workers in Havana held during the time of change. The results of the exploratory study reinforce and illustrate the common claim in the literature that wage differentiation based on equity principles receives broad support. At the same time, we show how principles of need and equality also have their place in the interviewees’ reasonings. Finally, we outline two different patterns that interviewees invoke to explain why they perceive equity violations as unjust.
Performance of steel beams with endplate connections exposed to fire
Authors: Rezaeian Abbas , Salehi Mohammad Sajjad , Kodur Venkatesh
Published: September 2024

This paper presents results from an experimental study on the fire behavior of endplate joints and the connected steel beams in a moment resisting frame (MRF). Utilizing the subframe assemblage, full-scale steel beams with various endplate connections were tested according to the ISO834 standard fire exposure. The thermal and structural responses of the beam and its endplate joints to the column, together with failure modes were monitored throughout the fire test. The effect of key factors such as endplate dimensions, bolt size and grade, and the presence of stiffeners were investigated. The results of the fire tests show that the specimen experiences flexural failure in 746–773°C temperature range, through mid-span deflection exceeding the deflection limit as per British standard 476. When the beam experienced a deflection greater than span/20, the endplate joints got fractured at about 40 min in to fire at temperatures higher than 815°C. The results also indicated that the endplate bending and the tensile fracture of the bolts control the failure of the endplate joint under fire exposure. The endplate connection details have a notable influence on the beam’s behavior under fire conditions, and the use of grade 10.9 bolts and wider endplates in the connection can improve the fire resistance of MRFs.
Epid data explorer: A visualization tool for exploring and comparing spatio-temporal epidemiological data
Authors: Viau Laetitia , Azé Jérôme , Chen Fati , Pompidor Pierre , Poncelet Pascal , Raveneau Vincent , Rodriguez Nancy , Sallaberry Arnaud
Published: September 2024

The analysis of large sets of spatio-temporal data is a fundamental challenge in epidemiological research. As the quantity and the complexity of such kind of data increases, automatic analysis approaches, such as statistics, data mining, machine learning, etc., can be used to extract useful information. While these approaches have proven effective, they require a priori knowledge of the information being sought, and some interesting insights into the data may be missed. To bridge this gap, information visualization offers a set of techniques for not only presenting known information, but also exploring data without having a hypothesis formulated beforehand. In this paper, we introduce Epid Data Explorer (EDE), a visualization tool that enables exploration of spatio-temporal epidemiological data. EDE allows easy comparisons of indicators and trends across different geographical areas and times. It facilitates this exploration through ready-to-use pre-loaded datasets as well as user-chosen datasets. The tool also provides a secure architecture for easily importing new datasets while ensuring confidentiality. In two use cases using data associated with the COVID-19 epidemic, we demonstrate the substantial impact of implemented lockdown measures on mobility and how EDE allows assessing correlations between the spread of COVID-19 and weather conditions.
Study nonlinear vibration characteristics of vibrating roller-subgrade coupled system in the initial and middle stages of vibratory compaction
Authors: Wang Yan , Lu Yongjie , Wang Jianxi , Liu Jingxu
Published: September 2024

The vibratory roller’s compaction in the initial and middle stages is crucial for transforming loose subgrade filler particles into a dense state. The subgrade shows nonlinear characteristics of large and small plastic deformation. To describe these nonlinear characteristics, a new nonlinear model of vibratory roller-soil coupling is proposed. Initially, a two-degree-of-freedom model of the vibrating roller-subgrade system is established, considering the subgrade’s vibration. A small parameter is introduced to improve the elastic element of the frame shock absorber and the subgrade’s nonlinear hysteresis model. The analytical solution of the proposed nonlinear dynamic equation is solved and verified by the numerical solution. Subsequently, the vibrating wheel’s nonlinear dynamic responses are studied, including time-frequency domain, Poincare section, and bifurcation diagrams. It is found that during the initial stage, increasing excitation frequency or decreasing excitation force causes the vibrating wheel’s response to shift from “double period” to “single period.” In the middle stage, the vibrating wheel’s motion exhibits three states: “chaos,” “double period,” and “single period.” These nonlinear vibration response characteristics provide a theoretical foundation for selecting intelligent compaction parameters.
An overview of computed tomography in corrosion science
Authors: Hughes A.E.
Published: September 2024

Computed tomography (CT) is used in many fields from medicine to materials science. CT covers a range of different techniques with most types falling into X-ray or electron generated. Generally, X-ray CT is nondestructively, electron techniques are a mixture: for nontransmission electron techniques (e.g., backscatter electrons) the sample needs to be sectioned, whereas transmission (such as TEM) can be done nondestructively. X-ray CT has been used to address a range of problems in corrosion from determining pit volumes in metals to determining the transport paths of inhibitor molecules within paint systems. Electron techniques have also been used with serial sectioning being the most common. Atom Probe tomography is another CT technique which recreates 3D volumes of a sample at the nanoscale and is based on ion position detected after ablation or evaporation. This overview highlights some of the work that has been performed in these areas.
Cancel Culture and Trigger-Ready Fragmented Interest Groups: The Case of Depp Versus Amber Heard
Authors: Jin Shangran , Bouvier Gwen
Published: September 2024

Using Multimodal Critical Discourse Analysis, this paper examines a sample of X hashtags supporting or criticizing Johnny Depp or Amber Heard in their 2022 domestic abuse/defamation trial, where in both cases there were calls to cancel each. The analysis explores how the acts carried out by the targets for canceling, along with concrete details of their personal circumstances, become set aside as what we call “trigger-ready” interest groups become activated by a perceived transgression in relation to their own more narrow and heterogeneous concerns. Hashtags become an entanglement of vaguely articulated discourses relating to matters including fandom, gender, abuse and conspiracy. These discourses stack up against the target and coalesce into growing outrage. The analysis suggests that intensity of canceling bares little relationship to any actual transgression but to the extent to which these “trigger-ready” groups become involved. This may be a characteristic of wider patterns in online cancel campaigns.
Fast-Food Outlets in Hospitals Affiliated With U.S. Medical Schools
Authors: Ali Zeeshan , Stancic Saray , Becker Roxanne , Herby Anna , Kondapalli Sankeerth K , Dombrower Alex M. , Barnard Neal D.
Published: September 2024

Objectives: To determine the current prevalence and type of fast-food outlets at medical-school-affiliated hospitals and compare them to previous findings to assess progress in improving the hospital food environment. Method: We invited medical students at 192 medical and osteopathic schools to complete Sogolytics surveys reporting on fast-food restaurants that are affiliated with their main teaching hospital or medical centers. Results: Of 192 medical and osteopathic schools, 255 individual completed surveys were received from 146 schools. 101 schools (69.2%) reportedly hosted at least one fast-food restaurant associated with the hospitals at which students rotate, these include 15.1% schools that gave a mixed response to the question if fast-food restaurants are present in any affiliated hospitals. 45 schools (30.8%) reported no fast-food restaurants in any affiliated hospitals. The five most common fast-food restaurants reported were Starbucks (27.9%), Subway (18.8%), Chick-fil-A (9.2%), Au Bon Pain (8.8%), and McDonald’s (5.4%). Regarding the statement, “It is acceptable for fast-food restaurants to be in hospitals,” 27.8% of students strongly disagreed, 29.0% somewhat disagreed, 16.9% neither agreed nor disagreed, 21.2% somewhat agreed, and only 5.1% strongly agreed. Conclusions: The majority of the teaching hospitals affiliated with the schools have at least one fast-food restaurant onsite.
Wait, Where Was I? Minimizing the Chaotic Moment Through Timeline Drawing Elicitation in Phone Interviews
Authors: Park Jiyea
Published: September 2024

This research arose from a moment when one of the author’s interviewees said, “Wait, where was I?” Through 60–90 minutes, in-depth phone interviews, shared highly detailed accounts of their personal stories of entering underemployment in South Korea. However, the first six interviewees talked about many different topics during their interviews, and confused the chronological sequences of multiple episodes. The interviewer recognized these instances as emergent chaotic moments, so she decided to incorporate various methods into her interviews. Among the many elicitation strategies that can be employed in qualitative interviewing, the author applied timeline elicitation to more accurately document their life events. Timeline elicitation is useful for extracting narratives of individual journeys and delineating the meaning of specific events. This technique proved the most effective strategy for minimizing confusions and successfully completing the interviews. This study used comparative analysis to assess the transcripts of two different groups (with/without applying timeline drawing elicitation), and presents findings showing their different reactions to dealing with the transition of time. This study demonstrated the potential of visual timeline approaches to reflect and illustrate the complexity of women participants’ experiences of underemployment. Moreover, the efficacy of this timeline drawing elicitation method will be critically discussed, along with its limitations within the context of innovative qualitative methodologies.
When feedback backfires: Knowledge of results can impair cognitive strategy choice
Authors: Weis Patrick P , Kunde Wilfried
Published: September 2024

Frequently, problems can be solved in more than one way. In modern computerised environments, more ways than ever exist. Naturally, human problem solvers do not always decide for the best-performing strategy available. One underlying reason might be the inability to continuously and correctly monitor each strategy’s performance. Here, we supported some of our participants’ monitoring ability by providing written feedback regarding their speed and accuracy. Specifically, participants engaged in an object comparison task, which they were asked to solve with one of two strategies: an internal strategy (mental rotation) or an extended strategy (manual rotation). After receiving no feedback (30 participants), trialwise feedback (30 participants), or blockwise feedback (30 participants) in these no choice trials, all participants were asked to estimate their performance with both strategies and were then allowed to freely choose between strategies in choice trials. Results indicated that written feedback improves explicit performance estimates. However, results also indicated that such increased awareness does not guarantee improved strategy choice and that attending to written feedback might tamper with more adaptive ways inform the choice. Thus, we advise against prematurely implementing written feedback. While it might support adaptive strategy choice in certain environments, it did not in the present setup. We encourage further research that improves the understanding of how we monitor the performance of different cognitive strategies. Such understanding will help create interventions that support human problem solvers in making better choices in the future.
A comparison between traditional children's rugby union games and modified small-sided games aimed at enhancing opportunity for physical activity and enjoyment
Authors: Tang Liz , Brade Carly J. , Hiscock Daniel J. , Shaw Jacob A. , Henley-Martin Sarah R. , Jacques Angela , Ducker Kagan J.
Published: September 2024

This study compared traditional rugby union (RU) games to a modified small-sided game (SSG) aimed at improving opportunity for physical activity and enjoyment in children. Twenty-six school rugby players (aged 10 y) played 10 RU matches. Five traditional games on a full-sized field with 10–12 players per team and five SSG on a modified field with seven players per team. Movement patterns, enjoyment, involvements (e.g., possessions, passes, tackles, rucks and tries), and heart rate (HR) were recorded. Session rating of perceived exertion (sRPE) was measured at the end of each game and used to calculate game load (sRPE x duration). Significance was set at p ≤ 0.05. Individuals covered greater distances (total, low and high speed) overall and relatively (per min) and had higher HR whilst playing traditional format RU. Despite covering greater distances, perceived exertion and game load were similar and importantly, enjoyment was high for both game formats. Individual player match involvements (overall and relative possessions and passes, and relative tackles) were higher in SSG. Given that players enjoyed both game formats, movement pattern and physiological data suggest traditional games may be more suitable for improving physical activity and fitness, while individual involvement data suggest SSG may be more suitable for improving opportunities for participation and skill development.
Functional Significance and Implications of Phyto-Oxylipins as Potential Anti-Cancer Agents
Authors: Dofuor Aboagye Kwarteng
Published: September 2024

Objective

Phyto-oxylipins are lipid molecules produced in plants by the oxidative transformation of unsaturated fatty acids via diverse metabolic pathways. Recently, the chemical diversity and functional significance of oxylipins is gaining significant attention. However, the functional significance of these compounds as anti-cancer agents remains largely uncharacterized. The objective of this review is to provide a comprehensive synthesis and analysis of the functional significance of plant oxylipins as anti-cancer agents to facilitate their exploitation in drug discovery and development.

Methods

This review was based on a thorough compilation and analysis of research work carried out on biological significance and implications of plant-derived anti-cancer oxylipins. Curation of data was based on several databases and resources such as Scopus, PubMed, DrugBank and PubChem. Within the context of the scope and subject matter as guided by the objective, no exclusion and inclusion criteria were necessarily employed in the screening of articles.

Results

The present review explores the origins, anti-cancer properties and functional mechanisms of phyto-oxylipins. The potential functional significance of new and poorly characterized plant oxylipins have also been highlighted. The prospects of plant oxylipins in research, medicine and biotechnology that could optimize their potential are also explored. Insights into the promising avenues that may originate from innovative therapeutic approaches are also discussed.

Conclusion

Despite the rich source of oxylipins in plants, much of their potential as therapeutic agents for cancer treatment remains to be fully established. Clinical investigations are also needed to determine safe doses and effective delivery methods. Research into phyto-oxylipins require significant attention due to the promise it may hold in addressing key challenges in biotechnology, health, and environmental sustainability.
The Impact of Socioeconomic Status on Pediatric Facial Trauma
Authors: Wright Avery , Hinson Madison , Davidson Amelia , Curtis Caitrin , Runyan Christopher
Published: September 2024

Study Design

Retrospective chart review.

Objective

Socioeconomic status (SES) greatly impacts one’s health status and the type of trauma that a patient experiences due to increased risk of exposure and varying availability of resources to treat emergent conditions. There is a need for large-scale databases of pediatric facial trauma to identify discrepancies in occurrence and identify risk factors.

Methods

This retrospective examination uses a multi-center database to evaluate pediatric facial trauma patients (n = 644) visiting Atrium Heath Wake Forest Baptist (AHWFB) hospital from 2020 to 2022. Data collected included demographic information, past medical and surgical history, trauma history, interventions, and long-term outcomes such as scarring, deformities, and sensory or motor deficits. The number of incidents for each zip code surrounding AHWFB was compared with SES data including unemployment rate, mean household income, and poverty level.

Results

Thirty-five percent of patients sustained a high-energy injury, and 65% sustained a low-energy injury. Within the surrounding counties of AHWFB, there were more incidents of pediatric facial trauma in areas with greater rates of poverty ( P = 0.006). Additionally, there were more incidents due to high-energy injuries in areas with lower income ( P = 0.044) and more poverty ( P = 0.002). Specifically, motor vehicle accidents were more common in areas with lower income ( P = 0.017) and more poverty ( P = 0.001).

Conclusions

These findings in the central Piedmont region of North Carolina are consistent with previous research of SES’s effect on health inequalities and serve as evidence of the need to take steps to prevent pediatric facial trauma in areas of low SES.
In- Versus Out-Fracture: A Novel Concept in Naso-Orbito-Ethmoid Injury
Authors: Menville Jesse , Soliman Luke , Shinde Nidhi , Spake Carole , Francalancia Stephanie , Marquez-Garcia Josue , Sobti Nikhil , Rao Vinay , Woo Albert S.
Published: September 2024

Study Design

A retrospective study.

Objective

The Markowitz-Manson classification system categorizes nasoorbitoethmoid (NOE) fractures by severity of injury and remaining integrity of the medial canthal tendon. However, this system does not account for direction of bony displacement (in-fracture vs out-fracture), which can greatly affect symptomatology and management. We hypothesize that NOE fractures will present differently based upon their severity: Type I injuries are likely to present with medial nasal bone displacement (in-fracture), whereas Type III fractures will be more prone to lateral displacement (out-fracture).

Methods

A retrospective review was performed for all patients with NOE fractures who were evaluated by the plastic surgery department at a level 1 trauma center over a 6-year period. Computed tomography data were evaluated to assess for directionality of fracture segment displacement. Frequencies of medial, lateral, and non-displacement across NOE types were compared by Chi-Squared Goodness of Fit and Fisher’s Exact Tests.

Results

111 patients met inclusion criteria. The patient population was 73.9% male and averaged 51.2 years old. When bilateral fractures were counted independently, there were 141 cases in total: 115 Type I, 20 Type II, and 6 Type III. Type I fractures were most commonly in-fractured (48.7%), while Type III injuries were consistently out-fractured (100%) ( p < .001).

Conclusions

While Type II and III NOE fractures have dominated clinical focus, this study highlights the prevalence of impaction within Type I fractures. These findings advocate for a more comprehensive approach to the evaluation of Type I NOE fractures and their potential risks, including traumatic hypotelorism and nasal airway obstruction.
Low-velocity impact on the sandwich beam with layered core
Authors: Solooki Mohammad
Published: September 2024

In this paper, a novel analytical and numerical study of low-velocity impact on a cantilever sandwich beams were carried out. Sandwich beams were made of stainless steel face-sheets and Aluminum foam core of fixed and variable density (layered). The governing equations are determined in the analytical section using the Galerkin procedure, and the velocity and acceleration equations of the sandwich beam are derived. ABAQUS software was also used to simulate this process. The results showed that there is good agreement between the numerical and analytical results and that density and arrangement of foam core layers have a significant effect on the deformation of the sandwich beam. In the following, the effect of some parameters such as mass, breadth and velocity of projectile and the strength of the foam core on the deflection of the top face-sheet were studied.
On Lefebvre's orientalism and geography's Eurocentrism in Sidaway's ‘critical Muslim geographies’
Authors: Clayton Daniel
Published: September 2024

This commentary picks up on how James Sidaway sets up his ‘critical Muslim geographies’ through a selective reading and critique of Western geography's Eurocentrism. It traces how Isaiah Bowman, Henri Lefebvre, and Neil Smith are used for this purpose, and then homes in on Sidaway's reading of Lefebvre's flippant Orientalism and elision of tier-mondism, suggesting that fuller investigation of this scene is warranted.
Predictors of Mothers Living with HIV Uptake of HIV Early Infant Diagnosis Services in Iringa District, Tanzania
Authors: Kyando Happy Alfayo , Tesha Novatus , Metta Emmy
Published: September 2024

Background

Uptake of HIV early infant diagnosis (HEID) among HIV-exposed infants is the key to timely initiation of Antiretroviral Treatment (ART). However, despite the availability of HEID services in Tanzania, its uptake is low. We aimed to determine predictors of mothers living with HIV’ with HIV-exposed infants’ uptake of HEID services in Iringa District, Tanzania.

Methods

A health facility-based cross-sectional study was conducted in Iringa District from May to June 2023. Mothers with HIV-exposed infants were recruited in the study through a multistage sampling technique and interviewed using pre-tested structured questions. Logistic regression analysis was employed to determine potential predictors of HEID uptake.

Results

A total of 309 mothers with HIV-exposed infants participated in the study. About 78.3% of the HIV-exposed infants had initial DNA PCR for HEID within 6 weeks of age and 86.1% within 8 weeks. Most mothers had high perceived benefits on uptake of HEID with a mean score of 4.3, high perceived self-efficacy with a mean score of 3.8 and 2.7 perceived risk of HIV infection on their HIV-exposed infants on the 5 scale Likert scale with 5 showing the highest perceived benefit, self-efficacy and risk. High perceived self-efficacy and being a businesswoman were the predictors of uptake of HEID. The odds of self-efficacy on the uptake of HEID by 2.4 times (aOR 2.4 95% CI 1.6–3.2) within 6 weeks of age and 1.9 (aOR 1.9 95% CI 1.3-2.7) within 8 weeks. The odds of being a businesswoman were 0.4 for 6 weeks and 0.3 for 8 weeks (aOR 0.4 95% CI 0.2-0.8) and (aOR 0.3 95% CI 0.1-0.8) respectively.

Conclusion

Over three-quarters of the HIV-exposed infants had initial DNA PCR for HEID testing as recommended. Perceived self-efficacy was the main factor influencing HEID uptake. These findings highlight the need for strengthening HIV-positive mother's self-efficacy for improved uptake of HEID services.
Long-term Outcomes of Partial Meniscectomy for Degenerative Medial Meniscus Posterior Root Tears
Authors: Lamba Abhinav , Regan Christina , Levy Bruce A. , Stuart Michael J. , Krych Aaron J. , Hevesi Mario
Published: September 2024

Background:

Previous studies have demonstrated that medial meniscus posterior root tear (MMPRT) repair is superior to debridement in terms of patient-reported outcomes, rates of conversion to total knee arthroplasty (TKA), and long-term costs. Despite the known poor midterm outcomes, there is a paucity of long-term results of partial meniscectomy for degenerative MMPRTs.

Purpose:

To 1) evaluate long-term patient-reported and radiographic outcomes of patients who underwent partial medial meniscectomy (PMM) for MMPRTs, and 2) determine the rate of and risk factors for conversion to total knee TKA.

Study Design:

Case series; Level of evidence, 4.

Methods:

A previously identified cohort of 26 patients treated with partial meniscectomy for isolated MMPRTs between 2005 and 2013 was prospectively followed for long-term outcomes at a minimum 10-year follow-up. Patients were evaluated for International Knee Documentation Committee (IKDC) outcome score, reoperation, and conversion to TKA. Failure was defined as conversion to arthroplasty or a severely abnormal IKDC subjective score <75.4.

Results:

This study included 26 patients (10 men, 16 women; mean age, 54 ± 8.7 years [range, 38-71 years] at diagnosis; body mass index, 32.9 ± 5.5) who were followed for a mean of 14.0 ± 3.6 years (range, 10.1-19.6 years). At the final follow-up, 1 patient was deceased and 18 (72%) of the remaining 25 patients had progressed to TKA, with 1 (4%) patient undergoing repeat meniscectomy. The 6 (24%) patients who had not progressed to TKA or revision surgery reported a mean IKDC score of 57 ± 23. Nineteen patients underwent subsequent surgery and 5 demonstrated severely abnormal IKDC scores resulting in a clinical failure rate of 96% (24 of the 25 living patients) at a mean 14-year follow-up.

Conclusion:

PMM for medial meniscus posterior horn root tears demonstrated 72% progression to TKA and 96% failure according to subjective clinical outcomes at a minimum 10-year follow-up.
Usability Considerations for Enhancing Exercise-Based Injury Prevention Interventions
Authors: Mørtvedt Anne Inger , Krosshaug Tron , Petushek Erich J.
Published: September 2024

Our study centers around the importance of usability and usability testing in the context of exercise interventions. Despite the proven effectiveness of exercise programs in reducing injuries, adherence to these programs remains a challenge, and injury rates have not decreased significantly. This study explores the application of usability testing in the field of health and exercise medicine, specifically assessing the usability of an exercise-based injury prevention intervention. A team of female handball players was included in the study (n = 23). The study employed a modified usability questionnaire, including items from the System Usability Scale (SUS), to evaluate important program characteristics (e.g. learnability, enjoyability, perceived effectiveness, ease of use, and efficiency). The Likert scale-based questionnaire was distributed within two sessions into the intervention period and post intervention. Perceived effectiveness, enjoyability, and efficiency highly correlated with players’ intention to use the program (rs 0.50, p = 0.02, rs 0.50, p= 0.02, rs 0.65, p < 0.001, respectively), whereas learnability and ease of use did not. Hence, the SUS items were not correlated with intention to use the program. Program usability, especially enjoyability, significantly decreased over time (Cohen’s d = 0.60, 95 % CI 0.13, 1.06, p = 0.01, and Cohen’s d = 0.61, 95 % CI 0.18, 1.10, p = 0.01, respectively). Our findings underscore the potential significance of considering program characteristics and usability testing throughout the development and testing of exercise programs. Moreover, this study highlights the shortcomings of current scales such as SUS and advocates for the creation of a tailored usability assessment tool for exercise interventions.
LEAN Rural Healthcare: Improving Rural Critical Access Hospital Laboratory Workflow to Optimize Processes
Authors: Courter Ben , Gardner Caleb , McCrory Bernadette
Published: September 2024

Background: Many studies have demonstrated the effect of Kaizen events in manufacturing, and research can be found of the implementation of Lean practices in a healthcare system. Healthcare systems currently studied are generally larger systems and the feasibility of implementing lean practices at a facility with less resources, including rural Critical Access Hospitals (CAH), has not be explored widely. Methods: A before-after analysis of a Lean Kaizen event project at a clinical laboratory within a rural CAH was conducted over a 2-week time period with a longer-term follow-up of 6 months. The project followed the Plan-Do-Check-Act (PDCA) cycle and the research team interviewed project members throughout the lifecycle. The Kaizen event improved turnaround time in the laboratory setting, assisted by tracking and eventually improving patient record management, and reduced travel time within the CAH’s laboratory setting. Results: The rural CAH had 18,514 tests over the course of December 2022 to November 2023. The turnaround time (TAT) for the current state was 111 minutes on average per order. Additionally, the laboratory had an 83% non-compliance rate for patient records management in the laboratory. The weighted average time went from 111 minutes to 44 minutes after the laboratory layout was changed. Routine orders went from 140 min to 41 minutes, and Timed orders went from 61 to 48 minutes. All processes had a positive change in TAT time for all three sets of orders. Conclusion: A rural CAH demonstrated significant improvement using a 2-week Kaizen event with a 6-month longitudinal follow-up. Important for CAH reimbursement and patient follow-up 83% of inspected patient records were in non-compliance rate from a 149-record sample size. After the implementation plan, the non-compliance rate fell to just 6% using Pareto, 5S and quality control using proper storage locations staff training on newly implemented procedures and workflows. Given the scarcity of time and personnel in CAHs, this project demonstrated dramatic improvements with just 2 personnel using rapid project implementation over a 14-day time period with follow-ups.
Early Investments for Teaming Dividends: A Human-Centered Approach to a Patient Decompensation Prediction Algorithm
Authors: Morey Dane A. , Gifford Ryan C. , Rayo Michael F.
Published: September 2024

Deployments of artificial intelligence (AI) and machine learning (ML) in healthcare can both help and harm patient outcomes, amplifying calls for a human-centered approach to AI/ML development. This paper details one approach guided by three principles: (1) pursue human-machine team (HMT) performance, not algorithm performance, (2) build interpretability throughout, and (3) constrain development to deconstrain interactions. We describe how these principles influenced our development of two algorithms predicting patient decompensation events five minutes into the future. These algorithms showed comparable performance to other similar models with enhanced interpretability that greatly expanded HMT interaction possibilities. Our early investments in the potential for teaming appeared to pay dividends for the resultant HMT.
Leveraging Expertise to Improve Safety – Insights and Lessons Learned From Collaborative Applied Human Factors Safety Work in a Maternal Neonatal Care Setting
Authors: Bañez Carleene , Subramaniam Kayathiri , Nercessian Silva , Soung Yee Anthony , Engel Katrina , Slomka Ashley , Gelmi Stefano , Farshait Nataly , McEwan Terri Stuart , Hall Trevor
Published: September 2024

Collaboration across Canada’s healthcare system is critical to improving safety in the high-risk area of maternal neonatal care. Oak Valley Health (OVH) and the Healthcare Insurance Reciprocal of Canada (HIROC) collaborated on two applied safety projects, leveraging expertise from both organizations. These projects sought to identify opportunities to improve teamwork, communication and workflow across the Childbirth and Children’s Service program at OVH. In Project 1, human factors specialists from HIROC implemented a series of front-line-focused ownership techniques to understand opportunities to improve teamwork and communication to support patient safety across the program. In Project 2, the study team used observations to map nurses’ movement during obstetrical triage and conducted a perceived mental workload assessment of nursing staff in the obstetrical triage area. We discuss the approach and results, as well as lessons learned from this collaborative work that can be shared in other healthcare contexts. Key learnings include insights into project scoping, and leveraging the clinical, human factors and other expertise from multiple organizations to proactively improve safety.
Gaining Insights from Subject Matter Experts to Develop a Racially and Culturally Appropriate Study in the Greater Toronto Area
Authors: Harris Maurita T. , Goonasekera Michelle , Boutros Helana M.
Published: September 2024

This study aims to develop a culturally relevant and inclusive needs assessment to inform the design of tailored technology solutions for Black older adults. Semi-structured, individual interviews were conducted with four Subject Matter Experts (SMEs) to ensure the larger study was tailored to the population's needs, including informing recruitment strategies. A three-member coding team conducted a content analysis on the interview transcriptions focusing on the research objectives. The findings provide valuable insights into best practices for conducting racially and culturally appropriate research and identify the everyday challenges Black older adults face in the Greater Toronto Area (GTA). Moreover, the findings underscore the significance of considering social determinants in study development and understanding the challenges. The discussions with the SMEs exemplify the importance of this methodology to ensure the study is relevant to the community in which they are situated. This study lays the groundwork for a deeper understanding of the challenges Black older adults in the GTA face and the potential solutions to address them.
Developing Socio-Technical Components of a Tele-Critical Care Consultation Service for Hospitalized Patients at Risk for Intensive Care Unit Admission
Authors: Abraham Joanna , Fritz Bradley , Pedamallu Lavanya , Palmer Chris
Published: September 2024

While a fraction of unplanned admissions to the intensive care unit are unavoidable and clinically warranted, a majority of unplanned admissions of lower-acuity patients can be avoided. In this study, we investigated the needs for developing and implementing a tele-critical care consultation (TC3) service at a large academic hospital in St. Louis, using an intervention mapping (IM) approach with input from a 10-member Stakeholder Advisory Board (SAB), including hospitalists, nurses, unit champions and leaders from the floor, and hospital rapid response team (RRT). We conducted four SAB meetings and identified three themes underlying the successful design and implementation of a tele-critical consult service: First, TC3 can streamline ICU admissions in one of two ways: by preventing avoidable, lower-acuity ICU admissions from floor, and by expediting unavoidable, higher-acuity admissions to the ICU from the floor. Second, TC3 can support three core functions remote monitoring, co-management, and clinical advisory. Third, TC3 workflow is comprised of TC3 service initiation, TC3 service care management, and TC3 service conclusion. We identified that the proposed TC3 service workflow can best be characterized as a socio-technical care system, as it heavily relies on technological components and human and social elements. We discuss the use of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to describe TC3 as a socio-technical system and interdependencies between its components and impact on outcomes.