bluuebunny/crossref_metadata_2025 huggingface dataset:
Director for hire? Negotiating creativity and work in the Irish television sector
Authors: Nelson Gerard , O’ Brien Anne
Published: February 2024

The television industry has deep-rooted neoliberal employment structures, and this article explores how the non-fiction television director negotiates this contingent working environment. Research has established that creative workers adapt themselves to the demands of a post-Fordist ‘gig economy’, characterised by casual, non-permanent work, with little security or accountability. However, relatively little is known about how non-fiction television directors respond to that context, especially in the Irish case. In-depth interviews were conducted with a purposeful sample of 12 freelance television directors. Key findings note the layers of control wielded by broadcasters over the working life of the director. Identifying the negative effect of broadcasters’ dominance in the sector, they revealed a three-line whip of control through budget, creative direction, and a risk-averse approach to programming, which effectively constrained the directors and reduced their autonomy. The directors described how broadcasters’ control over budgets means that the sector is run at their command, a situation that is further aggravated by Ireland’s lack of trade union representation, stagnant pay rates and the absence of intellectual property rights accruing to directors’ work. Respondents proposed that their status was reduced from creative auteur to operational functionaries, reporting the negative impact of the industry work culture and practices on their self-esteem, because their creativity and work were undervalued. This article breaks new ground to explore directors’ responses to the conditions of the gig economy and link the alienation of labour to the loss of creativity in content. There was an acceptance by non-fiction directors of the status quo, which was seen as the ‘price’ of a non-routine life, with the freedom to indulge the passion and the pleasure inherent to making television. Moreover, respondents also revealed how they maintained their creative identity despite their circumstances, through the pursuit of their own work and through the support of peers. Crucially, respondents argued for a repositioning of the television director to reflect their status and role in the origination and creation of novel content, and proposed such recognition might better serve the television viewer.
Assessing critical fracture energy in mode I for bonded composite joints: A numerical–experimental approach with uncertainty analysis
Authors: Beck Rafael , da Silva Jailto Antonio Prado , da Silva Lucas FM , Tita Volnei , de Medeiros Ricardo
Published: February 2024

The manufacturing process of composite structural components involves the assembly of composite parts using adhesives, which introduces variations in the geometrical and mechanical properties of bonded joints. The fracture energy under mode-I loading ( G I c) is a parameter used to predict crack propagation and evaluate the residual strength of the joint. This work proposes a numerical-experimental procedure to determine G I c in mode I, while considering the uncertainties inherent in the manufacturing process of bonded joints. The proposed procedure employs a three-dimensional finite element model to simulate a double cantilever beam test, using finite element commercial software. The cohesive zone model is applied to simulate the mechanical behavior of the adhesive, and experimental data are used to feed the computational model. A Plackett-Burman design is performed to reduce the number of experiments and evaluate the effect of the main influence parameters. Force-displacement curves are obtained, the compliance-based beam method is applied to determine G I c in mode I, employing both trapezoidal and triangular traction-separation laws. The results are thoroughly examined, taking into account the potential strengths and limitations of the proposed procedure, particularly in its application to predicting the behavior of bonded composite joints under mode I loading conditions. The proposed approach can help to understand the uncertainties effect related to the manufacturing process of bonded joints on G I c values, and improve the reliability of predicting crack propagation and residual strength assessment in bonded joints.
Viewing life as a timeline: Digital visual research to retrace people's journeys
Authors: Baú Valentina
Published: February 2024

This research note introduces the experience of using ‘timelines’ as a visual research method during online interviewing. It does so through a series of questions and answers that guide the reader through an exploration, understanding of and reflection on the method. This qualitative approach was used while conducting research on the influence that participation in a Reality TV show had on its finalists, and on the opportunities and life choices that were afforded to participants after the end of the show. The reader is encouraged to draw links between their own work as a qualitative researcher and the possibilities that this method can offer either in filling gaps or in expanding their current endeavour. Ultimately, the ‘quality’ of the answers we find in our qualitative work is illustrative of the way we choose to ask our questions.
COVID-19 and Political Trust in Local Governments: Evidence From Nepal
Authors: Fiedler Charlotte , Marcos-Marne Hugo , Mross Karina
Published: February 2024

The COVID-19 pandemic has reinvigorated debates about the drivers of political trust. Research so far has mainly focused on national-level institutions, during the early stages of the pandemic and using data from established democracies. However, how does this relationship look like if we pay attention to subnational institutions in non-consolidated democracies, and further away from the initial COVID-19 outbreak? To contribute to this line of research, this article focuses on the local level and explores the association between individuals’ satisfaction with COVID-19 performance and political trust in Nepal. For that, it uses novel data collected via telephone interviews (N = 1400) conducted between 25 April and 24 May 2021, during the second wave of COVID-19. Our main results reveal that satisfaction with local institutions’ COVID-related performance is significantly and robustly associated with levels of political trust at the local level. The association holds even when geographical and time specifications are added, trust towards national institutions or expectations about local governments are included in the analysis and the dependent variable is disaggregated to discard measurement biases. The study thereby provides important insights into the role performance plays for institutional trust beyond the national level and in an unconsolidated democracy.
Discrete wavelet transform based processing of embroidered textile-electrode electromyography signal acquired with load and pressure effect
Authors: Etana Bulcha Belay , Dawud Ahmed Ali , Malengier Benny , Sitek Wojciech , Gemechu Wendimu Fanta , Krishnamoorthy Janarthanan , Langenhove Lieva Van
Published: February 2024

The diagnosis of neuromuscular diseases is complicated by overlapping symptoms from other conditions. Textile-based surface electromyography (sEMG) of skeletal muscles, offer promising potential in diagnosis, treatment, and rehabilitation of various neuromuscular disorders. However, it is important to consider the impact of load and pressure on EMG signals, as this can significantly affect the signal’s accuracy. This study seeks to investigate the influence of load and pressure on EMG signals and establish a processing framework for these signals in the diagnosis of neuromuscular diseases. The sEMG data were collected from healthy subjects using a textile electrode developed from polyester multi-filament conductive hybrid thread (CleverTex). The textrode was embroidered directly on an elastic bandage (Velcro® strap) placed on volunteer’s muscles while different activities were performed with varying loads and pressure. The collected data were pre-processed using standard techniques of the discrete wavelet transform to remove noise and artifacts. The performance of the proposed denoising algorithm was evaluated using the signal-to-noise ratio (SNR), percentage root mean square difference (PRD), and root mean square error (RMSE). Various signal processing approaches (filters) were considered and the results were compared with the proposed EMG noise reduction algorithms. Based on the experimental results, the fourth level of decomposition for the sym5 wavelets with the Rigrsure threshold method achieved the highest signal-to-noise ratio (SNR) values of 16.69 and 21.91, for soft and hard thresholding functions, respectively. The SNR values of 22.11, 21.54, and 2.78 at three different pressure levels 5 mmHg, 10 mmHg, and 20 mmHg, respectively, indicate the superior performance of wavelet multiresolution filter in de-noising applications. The results of this study suggest that our methodology is effective, precise, and reliable for analysing sEMG data and provide insights into both physiological and pathological neuromuscular conditions.
Unsuspected Limitations of 3D Printed Model in Planning of Complex Aortic Aneurysm Endovascular Treatment
Authors: Bonvini Stefano , Raunig Igor , Demi Libertario , Spadoni Nicola , Tasselli Sebastiano
Published: February 2024

Objective

Static 3-dimensional (3D) printing became attractive for operative planning in cases that involve difficult anatomy. An interactive (low cost, fast) 3D print allowing deliberate surgical practice can be used to improve interventional simulation and planning.

Background

Endovascular treatment of complex aortic aneurysms is technically challenging, especially in case of narrow aortic lumen or significant aortic angulation (hostile anatomy). The risk of complications such as graft kinking and target vessel occlusion is difficult to assess based solely on traditional software measuring methods and remain highly dependent on surgeon skills and expertise.

Methods

A patient with juxtarenal AAA with hostile anatomy had a 3-dimensional printed model constructed preoperatively according to computed tomography images. Endovascular graft implantation in the 3D printed aorta with a standard T-Branch Cook (Cook® Medical, Bloomington, IN, USA) was performed preoperatively in the simulation laboratory enabling optimized feasibility, surgical planning and intraoperative decision making.

Results

The 3D printed aortic model proved to be radio-opaque and allowed simulation of branched endovascular aortic repair (BREVAR). The assessment of intervention feasibility, as well as optimal branch position and orientation was found to be useful for surgeon confidence and the actual intervention in the patient. There was a remarkable agreement between the 3D printed model and both CT and X-ray angiographic images. Although the technical success was achieved as planned, a previously deployed renal stent caused unexpected difficulty in advancing the renal stent, which was not observed in the 3D model simulation.

Conclusion

The 3D printed aortic models can be useful for determining feasibility, optimizing planning and intraoperative decision making in hostile anatomy improving the outcome. Despite already offering satisfying accuracy at present, further advancements could enhance the 3D model capability to replicate minor anatomical deformities and variations in tissue density.
Standardized approach to direct first pass aspiration technique for endovascular thrombectomy: Description and initial experience with CANADAPT
Authors: Macdonald I.R. , Linehan V. , Sneek B. , Volders David
Published: February 2024

Background

Endovascular thrombectomy (EVT) is standard of care for acute ischemic stroke. Stent assisted EVT with aspiration (SOLUMBRA) technique has remained a mainstay approach. There is growing evidence that A Direct Aspiration First Pass Technique (ADAPT) is a safe, efficient and effective approach for EVT, offering several advantages. This study describes and reports initial institutional experience in the use of a standardized scientific based aspiration only technique: CANADAPT.

Methods

Single center prospective cohort study was performed on consecutive patients treated for large/medium vessel ischemic stroke with CANADAPT. Intravenous thrombolytics were administered according to routine practice, independent of the decision to proceed with EVT. A sequential stepwise aspiration only technique was then applied, CANADAPT, consisting of three maneuvers, A, B and C. The reperfusion success rate, number of passes, use of rescue technique, complication rate and procedural cost were determined.

Results

Twenty-two patients were included in this case series representing M1 (17, 77%), M1/2 (2, 9%), carotid-T (2, 9%) and basilar (1, 5%) occlusions. First pass recanalization was achieved in 11 (50%) of patients. A further four patients had successful reperfusion with a second pass of CANADAPT (total 68% success rate). Only one patient had successful reperfusion with the aspiration catheter at the clot interface (CANADAPT A). All others required some withdrawal of the aspiration catheter for reperfusion (CANADAPT B and C). Seven patients had SOLUMBRA rescue. Of these, five patients (22% of total patients) had further successful reperfusion. Overall median procedural time was 23 min for first recanalization and 30 min for final recanalization. The cost per procedure was $6630 ± 1069 for CANADAPT, and $13,530 ± 2706 for SOLUMBRA techniques.

Conclusions

CANADAPT represents a standardized scientific-based approach to aspiration only thrombectomy intervention. This initial study demonstrates the safety, efficiency and efficacy of this technique for use in EVT.
Independent risk factors for in-hospital outcome of myasthenic crisis: a prospective cohort study
Authors: Wang Yuan , Huan Xiao , Zhu Xinfang , Song Jie , Yan Chong , Yang Lei , Xi Caihua , Xu Yafang , Xi Jianying , Zhao Chongbo , Xia Rong , Luo Sushan
Published: February 2024

Background:

Myasthenic crisis (MC) is a life-threatening condition for myasthenia gravis (MG). Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIg) efficaciously treat patients with MC. However, not every MC responds well to rescue therapies, and the determinants for outcome with the evidence from prospective cohorts are still lacking.

Objectives:

To explore the risk factors for in-hospital outcomes in patients with MC.

Methods:

Using a national neuromuscular center-based cohort of MG with prospective follow-ups from the crisis to the post-crisis phase, we finally included 90 MC episodes from 76 independent patients who received a standard regimen of rescue therapies.

Results:

The mean admission age was 52.89 ± 15.72 years. With a female predominance of 63.16% (48/76) and a high proportion of thymoma-associated MG (TMG) of 63.16% (48/76), the overall in-hospital mortality was 2.63% (2/76) and the average duration for mechanical ventilation (MV) use was 17.09 ± 13.36 days (0–53 days). In contrast to the patients with anti-acetylcholine receptor (AChR) antibodies, muscle-specific tyrosine kinase (MuSK)-associated MC exhibited a shorter MV support (5.20 ± 5.07 versus 17.40 ± 13.24 days, p = 0.023), length of intensive care units (ICU) stay (6.00 ± 4.64 versus 19.16 ± 17.54 days, p = 0.046), and hospital stay (16.00 ± 4.12 versus 34.43 ± 20.48 days, p = 0.011). Thymoma [odds ratio (OR): 0.200, 95% confidence interval (CI): 0.058–0.687, p = 0.011], partial pressure of carbon dioxide (PCO2) in blood gas before MV (OR: 1.238, 95% CI: 1.015–1.510, p = 0.035), and pneumonia (OR: 0.204, 95% CI: 0.049–0.841, p = 0.028) were identified as independent risk factors for prolonged MV use. TMG patients with thymoma burden exhibited a notable longer MV use (22.08 ± 17.54 versus 8.88 ± 6.79 days, p = 0.001), a prolonged hospital stay (40.40 ± 26.13 versus 23.67 ± 13.83 days, p = 0.009) compared with non-TMG. Even with complete thymoma resection (R0), TMG exhibited an unfavorable outcome versus non-TMG.

Conclusion:

With timely rescue therapies and prospective follow-ups, the in-hospital outcome of MCs was substantially improved. Thymoma, PCO2 in blood gas before MV, and pneumonia were identified as independent risk factors for prolonged MV use.
Chronological improvement of survival in patients with advanced gastric cancer over 15 years
Authors: Ogata Takatsugu , Narita Yukiya , Oze Isao , Kumanishi Ryosuke , Nakazawa Taiko , Matsubara Yuki , Kodama Hiroyuki , Nakata Akinobu , Honda Kazunori , Masuishi Toshiki , Bando Hideaki , Taniguchi Hiroya , Kadowaki Shigenori , Ando Masashi , Ito Seiji , Tajika Masahiro , Muro Kei
Published: February 2024

Background:

Recent trials have reported a median overall survival (OS) of 11–17 months in patients with advanced gastric cancer (AGC). However, it is unclear how recently approved drugs contribute to patient prognosis.

Objectives:

We aimed to evaluate the characteristics and survival in patients with AGC over the past 15 years.

Design:

Retrospective study.

Methods:

We evaluated data of 1355 patients with AGC who received first-line chemotherapy between January 2005 and March 2019 at a single institution. We compared the characteristics and survival rates across four periods: January 2005–December 2007 (period A), January 2008–February 2011 (period B), March 2011–May 2015 (period C), and June 2015–March 2019 (period D). The median follow-up duration was 13.1 months, with 312, 333, 393, and 317 patients in periods A, B, C, and D, respectively.

Results:

There were no significant differences in patient characteristics between the four periods, except for the proportion of patients who underwent prior gastrectomy and human epidermal growth factor receptor 2 (HER2) testing. Patients in period D had significantly longer OS than those in period A [median: 15.7 versus 12.4 months; adjusted hazard ratio (aHR): 0.79; p = 0.02]. The mean OS in patients with liver metastasis (LM) in period D was remarkably longer than that in patients in period A (median: 19.3 versus 12.4 months; aHR: 0.61; p < 0.01), while that in patients with peritoneal metastasis showed limited improvement.

Conclusion:

Clinical strategy changes, including gastrectomy, HER2 testing, and approval of new drugs, may be associated with improved OS in patients with AGC. In the last 4 years, a remarkable improvement has been observed in patients with LM.
Current and Future Treatment of Food Allergies
Authors: Hearrell Melissa L.
Published: February 2024

Food allergy prevalence is rapidly growing among school-age children in the United States, posing a significant health concern in school settings. This article aims to provide an overview of the current state of food allergy treatment options, emergency food allergy care plans, and using epinephrine autoinjectors. In addition, it explores potential future treatment options, including immunotherapy and novel therapeutic approaches. This article emphasizes the crucial role of school nurses in recognizing the treatment options currently available to students and their families, as well as fostering a safe environment for students with food allergies.
The effect of adult coloring (mandala pattern) on pain and anxiety associated with dressing changes in burn patients: A randomized controlled trial
Authors: Sadeqi Hamidreza , Rahzani Kobra , Hekmatpou Davood , Rakei Isfahani Siamak
Published: February 2024

Introduction

The study investigated the effect of mandala coloring on pain and anxiety associated with dressing changes in burn patients.

Method

This clinical trial was conducted on 60 patients in two groups. At the beginning of the study [baseline (T1)], anxiety and pain were assessed using the BSPAS and VAS. A mandala pattern with colored pencils was provided to the patients in the intervention group. Each patient was given 30 min to color. Anxiety was measured at the 35th minute (T2). A dressing change was performed and 15 min later, the variables were measured again (T3). The control group received no intervention.

Results

The mean anxiety at the baseline (T1), 35th minute (T2), and 15 min after dressing changes (T3) in the intervention and control groups were 38.73  ±  5.55, 26.20  ±  6.08 and 28  ±  8.53, and 39.17  ±  4.17, 41.27  ±  3.68 and 41.63  ±  2.97, respectively. Anxiety at T1 was at the same for both groups. The anxiety in the intervention group decreased (P < 0.001) at T2 and T3 and increased in the control group. The mean pain intensity at the baseline (T1) and 15 min after dressing changes (T2) in the intervention group was 8.47  ±  1.432 and 5.9  ±  1.9, respectively, and in the control group was 8.33  ±  0.802 and 8.77  ±  0.626. Pain intensity at T1 was at the same level for both groups. The pain in the intervention group decreased at T2 (P < 0.001), whilst it increased in the control group.

Conclusion

Mandala coloring can reduce pain and anxiety during dressing changes in burn patients. It can be used as adjuvant treatment.

Lay Summary

Wound dressing in burn patients is accompanied by pain. This painful experience can lead to wound dressing anxiety in these patients. For this purpose, a study was conducted to check whether coloring before wound dressing can reduce the pain and anxiety of dressing in adults. Two groups of patients were included in the study; before the dressing, one group received a pre-prepared image of mandela designs along with colored pencils and colored the design to their taste. The other group did not receive any intervention. The intensity of pain and the level of anxiety of the two groups were measured before and after the dressing. The results showed that the coloring of the mandela design before dressing reduced the pain and anxiety related to the proceedure.
College Women’s Perceptions of A Friend-Based Intervention to Prevent Alcohol-Involved Sexual Assault
Authors: Livingston Jennifer A. , Wiseblatt Aria , Biehler Kaitlyn M. , Shaw Rachael J. , Read Jennifer P.
Published: February 2024

Sexual assault (SA), particularly alcohol-involved SA, remains prevalent among college women. Because SA often begins in social contexts, bystander intervention has become a popular approach to prevention. Bystander interventions train individuals to intervene on behalf of others, including strangers, despite research indicating that intervention is more likely to occur when the bystander has a relationship with the target. Shifting the focus to friends as potential bystanders capitalizes on the qualities of relationship and responsibility that facilitate intervention. College women ( N = 35) participated in focus groups ( N = 8) during which they viewed a video prototype of a friend-based motivational interviewing (FMI) intervention session conducted with a friend dyad and provided feedback about the relevance and feasibility of using such an approach to reduce SA among friends who drink together in social settings. Content analysis of focus group transcripts yielded three themes: (a) Friends as Natural Bystanders, (b) The Role of Alcohol in Intervention, and (c) Receptivity to FMI intervention. Women indicated that they feel responsible for keeping their friends safe and that this sense of responsibility facilitates helping behaviors. Women also described ways through which alcohol intoxication can affect helping behavior. Women expressed enthusiasm for the FMI intervention approach and identified its emphasis on friendship and flexible approaches to personal safety as strengths. Findings highlight the promise of FMI intervention approaches that capitalize on the strengths of women’s friendship to create safety goals that align with participants’ values and overcome barriers to intervention, including alcohol intoxication.
Triple Gram-negative bacterial endophthalmitis following intravitreal injection
Authors: Zaher Samy , Rodriguez-Villalobos Hector
Published: February 2024

Purpose

To describe a puzzling case of endophthalmitis caused by three unusual bacteria after intravitreal injection, its outcome, and underlying questions.

Findings

A 70-year-old female patient was diagnosed with acute endophthalmitis following intravitreal aflibercept injection for age-related macular degeneration. A standard tap and inject procedure was performed. Microbiological analyses on the anterior chamber and vitreous samples yielded the presence of three non-fermenting Gram-negative rods: Pseudomonas stutzeri, Stenotrophomonas maltophilia, and Ochrobactrum anthropi. The outcome was favorable after intravitreal injections of vancomycin and ceftazidime, with an almost complete recovery of the visual acuity to its baseline level. No potential source of infection was identified.

Conclusion

Endophthalmitis following intravitreal injection can be caused by a wide variety of bacteria, including some rare Gram-negative species. They can sometimes co-exist in a single patient, but their virulence may vary greatly. Due to the variable antibiotic susceptibility and frequent multiresistance associated with non-fermenting Gram-negative rods, a prompt microbiological approach is required. Favorable outcome can be achieved with standard management.
A scoping review on the conceptualisation and impacts of new mobility services
Authors: Mubiru Ibrahim , Westerholt René
Published: February 2024

In the course of major societal developments such as digitalisation and increasing urbanisation, various forms of so-called new mobility services have emerged. Various disciplines are engaged in understanding these services. However, what is still missing is a comprehensive understanding of what the umbrella term new mobility services means beyond a loosely used catch-all term. This article provides an interdisciplinary overview of the concept of new mobility services and their respective impacts on mobility landscapes. These aspects are summarised using a scoping review approach by examining a total of 98 publications. Our results show that the term new mobility services is indeed an umbrella term for different mobility concepts that are conceptualised differently and whose impacts on mobility landscapes are manifold. However, by applying elements of formal concept analysis, we can identify several key characteristics that define the lowest common denominator for services to be classified as new mobility services.
The PPO family in Nicotiana tabacum is an important regulator to participate in pollination
Authors: Wei Xuemei , Tao Keliang , Liu Zhengmei , Qin Boyuan , Su Jie , Luo Yanbi , Zhao Chunwen , Liao Jugou , Zhang Junpeng
Published: February 2024

Polyphenol oxidases (PPOs) are type-3 copper enzymes and are involved in many biological processes. However, the potential functions of PPOs in pollination are not fully understood. In this work, we have screened 13 PPO members in Nicotiana. tabacum (named NtPPO1-13, NtPPOs) to explore their characteristics and functions in pollination. The results show that NtPPOs are closely related to PPOs in Solanaceae and share conserved domains except NtPPO4. Generally, NtPPOs are diversely expressed in different tissues and are distributed in pistil and male gametes. Specifically, NtPPO9 and NtPPO10 are highly expressed in the pistil and mature anther. In addition, the expression levels and enzyme activities of NtPPOs are increased after N. tabacum self-pollination. Knockdown of NtPPOs would affect pollen growth after pollination, and the purines and flavonoid compounds are accumulated in self-pollinated pistil. Altogether, our findings demonstrate that NtPPOs potentially play a role in the pollen tube growth after pollination through purines and flavonoid compounds, and will provide new insights into the role of PPOs in plant reproduction.
Effects of pressure-controlled ventilation targeting end-inspiratory flow rate on pulmonary complications and inflammation levels in patients undergoing spinal surgery in the prone position: a randomized clinical trial
Authors: Wang Na , Ye Yong , Lin Hui , Sun Tingting , Hu Yue , Shu Yuanhang , Tong Jing , Tao Yong , Zhao Zeyu
Published: February 2024

Background

This study assessed the impact of pressure-controlled ventilation (PCV) focusing on end-inspiratory flow rate on the incidence of postoperative pulmonary complications (PPCs) and inflammation levels in patients undergoing spinal surgery in the prone position.

Methods

A total of 187 patients who underwent posterior spinal surgery were enrolled and randomly divided into 3 groups: 61 in the volume-controlled ventilation (VCV) group (group V), 62 in the PCV-volume-guaranteed (VG) group (group P1), and 64 in the PCV-VG end-expiratory zero flow rate group (group P2). Indicators including tidal volume (VT), peak airway pressure (Ppeak), and dynamic lung compliance (Cdyn) were recorded. The Ppeak, Cdyn, PETCO2, and oxygenation index (PaO2/FiO2) after intubation (T0), after prone position (T1), 60 min after prone position (T2), and after supine position at the end of surgery (T3) of the three groups were collected.

Results

In the within-group comparison, compared with T0, Ppeak increased at T1 − 2 in groups V and P1 (P < 0.01), whereas it decreased at T1 − 3 in group P2 (P < 0.01). Cdyn decreased at T1 − 2 and PaO2/FiO2 increased at T1 − 3 in all three groups (P < 0.01), and PaO2/FiO2 increased at T1 − 3 (P < 0.01). Compared with group V, Ppeak decreased at T0 − 3 in group P1 (P < 0.01) and at T1 − 3 in group P2 (P < 0.01), while Cdyn increased at T0 − 3 in groups P1 and P2 (P < 0.01). Compared with group P1, Ppeak was elevated at T0 (P < 0.01) and decreased at T1 − 3 (P < 0.05), and Cdyn was elevated at T0 − 3 in group P2 (P < 0.01). The total incidence of PPCs in group P2 was lower than that in group V (P < 0.01). Compared with the preoperative period, serum interleukin 6 (IL-6) and C-reactive protein (CRP) levels were increased at 24 and 72 h after surgery in group V (P < 0.01), whereas that was increased at 24 h after surgery in group P1 and group P2 (P < 0.01). Compared with group V, serum IL-6 and CRP levels were reduced at 24 h after surgery in groups P1 and P2 (P < 0.01 or < 0.05).

Conclusion

In patients undergoing spinal surgery in the prone position, PCV-VG targeting an end-inspiratory zero flow rate lowers the incidence of PPCs and inflammation levels.
Early supported discharge for older adults admitted to hospital after orthopaedic surgery: a systematic review and meta-analysis
Authors: Williams Susan , O’Riordan Cliona , Morrissey Ann-Marie , Galvin Rose , Griffin Anne
Published: February 2024

Background

Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients to return home, continuing to receive the necessary input from healthcare professionals that they would otherwise receive in hospital. Existing literature demonstrates the concept having a reduced length of stay in stroke inpatients and medical older adults. This systematic review aims to explore the totality of evidence for the use of ESD in older adults hospitalised with orthopaedic complaints.

Methods

A literature search of Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL), EMBASE, CINAHL and MEDLINE in EBSCO was carried out on January 10th, 2024. Randomised controlled trials or quasi-randomised controlled trials were the study designs included. For quality assessment, The Cochrane Risk of Bias Tool 2.0 was used and GRADE was applied to evaluate the certainty of evidence. Acute hospital length of stay was the primary outcome. Secondary outcomes included the numbers of fallers and function. A pooled meta-analysis was conducted using RevMan software 5.4.1.

Results

Seven studies with a population of older adults post orthopaedic surgery met inclusion criteria, with five studies included in the meta-analysis. Study quality was predominantly of a high risk of bias. Statistically significant effects favouring ESD interventions were only seen in terms of length of stay (FEM, MD = -5.57, 95% CI -7.07 to -4.08, I2 = 0%). No statistically significant effects favouring ESD interventions were established in secondary outcomes.

Conclusion

In the older adult population with orthopaedic complaints, ESD can have a statistically significant impact in reducing hospital length of stay. This review identifies an insufficient existing evidence base to establish the key benefits of ESD for this population group. There is a need for further higher quality research in the area, with standardised interventions and outcome measures used.
Steroid-resistant minimal change nephrotic syndrome associated with thymoma treated effectively with rituximab following thymectomy and cyclosporine: a case report
Authors: Watanabe Yusaku , Hirai Keiji , Hirata Momoko , Kitano Taisuke , Ito Kiyonori , Ookawara Susumu , Oshiro Hisashi , Morishita Yoshiyuki
Published: February 2024

Background

Minimal change nephrotic syndrome (MCNS) can be complicated by thymoma; however, no standard therapy for thymoma-associated MCNS has yet been established. We herein describe a case of steroid-resistant MCNS associated with thymoma, treated effectively with rituximab.

Case presentation

A 71-year-old Japanese man was referred to our department with severe proteinuria (20 g/gCr). Renal biopsy showed minimal change disease and computed tomography revealed an anterior mediastinal mass. Based on these findings, he was diagnosed with thymoma-associated MCNS. He was treated with oral prednisolone (50 mg/day) and cyclosporine, and underwent thymectomy and plasma exchange. However, no improvement in proteinuria was observed. He therefore received intravenous rituximab 500 mg, resulting in a marked decrease in proteinuria from 5328 to 336 mg/day after 1 week.

Conclusions

This case suggests that rituximab might be an effective therapy in patients with steroid-resistant MCNS associated with thymoma.
Arterial transit artifact as a short-term prognostic indicator in acute ischemic stroke
Authors: Shan Min , Liu Kaili , Ma Yi , Zhang Qingxiu , Yun Wenwei , Zhang Min
Published: February 2024

Background

Arterial transit artifact (ATA) observed on arterial spin labeling (ASL) was recently suggested to be associated with improved functional outcomes following acute ischemic stroke (AIS). AIS is a heterogeneous disease with diverse pathogenic mechanisms depending on the stroke subtype. This study aimed to investigate the association between ATA and 3-month functional outcomes in AIS patients according to etiology subtypes.

Methods

Consecutive patients with AIS were included. All patients underwent ASL MRI with postlabeling delay (PLD) of 1.5 and 2.5 s. ATA was assessed from the ASL images of both PLDs. Stroke etiologic subtypes were determined according to the modified TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification. Short-term functional outcomes were evaluated using the 3-month modified Rankin scale (mRS). Log-binomial regression was applied to analyze the association between ATA and functional outcomes at 3 months after stroke.

Results

Ninety-eight AIS patients (62.73 ± 13.05 years; 68 men) were finally included. ATA was detected in forty-six patients and most frequently seen in the large-artery atherosclerosis (LAA) subtype (35/46). The ATA group exhibited a lower percentage of patients with mRS > 2 compared to the group without ATA (36.5% vs. 19.6%; P < 0.001). ATA was independently associated with better 3-month clinical outcomes (adjusted risk ratio, 0.35[95% CI, 0.16—0.74]) in the multivariate log-binomial regression model. After stratification by TOAST subtypes, a significant association was found between ATA and better outcomes in the LAA subtype (adjusted risk ratio, 0.20[ 95% CI, 0.05—0.72]) but not in cardioembolism and small artery occlusion (SVO) subtype.

Conclusion

ATA is associated with better outcomes at 3 months in patients with AIS, especially in the LAA subtype, but this association attenuated in the cardioembolism and SVO subtypes.
Impacts of systemic treatments on health-related quality of life for patients with metastatic colorectal cancer: a systematic review and network meta-analysis
Authors: Jiang Yunlin , Zhao Mingye , Tang Wenxi , Zheng Xueping
Published: February 2024

Objective

There is limited evidence of comparative results among different treatments regarding impacts of Health-Related Quality of Life (HRQoL) for patients with metastatic colorectal cancer (mCRC). We aimed to compare efficacy of systemic treatments on HRQoL among patients with mCRC.

Methods

We collected randomized controlled trials (RCTs) reported in English up until July 2023, from databases including PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and prominent conference databases, for this Bayesian network meta-analysis. Phase 2 or 3 trials that evaluated at least two therapeutic regimens were included. Primary outcomes were short-term and long-term mean changes in EORTC QLQ-C30 global health status/quality of life (GHS/QoL) scores. Secondary outcome was mean change in EQ-5D health utility scores. Mean differences (MDs) with 95% confidence intervals (CIs) were used as effect size. Subgroup analysis was performed based on whether patients received systemic treatments before. We conducted various sensitivity analyses, including differentiating between chemotherapy types, and analyzed patient cohorts with non-specified gene expression levels as well as those with target KRAS expression statuses. The current systematic review protocol was registered on PROSPERO (CRD42023453315 and CRD42023420498).

Results

Immunotherapy and targeted therapy significantly improved HRQoL over chemotherapy, with MDs of 9.27 (95% CI: 3.96 to 14.6) and 4.04 (95% CI: 0.11 to 7.94), respectively. Monotherapy significantly outperformed both combination therapy (MD 5.71, 95%CI 0.78 to 10.63) and no active treatment (MD 3.7, 95%CI 1.41 to 6.01) regarding GHS/QoL in the short-term. Combining targeted therapy with chemotherapy did not improve HRQoL. Focusing on HRQoL, cetuximab excelled when gene expression baselines were unspecified. Subgroup and sensitivity analyses upheld these robust findings, unaffected by model or patient baseline characteristics. Evidence from clinical trials without specific gene level data suggested that monotherapies, especially targeted therapies such as cetuximab, demonstrated superiority in HRQoL. For KRAS wild-type patients, no significant HRQoL differences emerged between chemotherapy, targeted therapy, or their combination..

Conclusions

Targeted therapies and immunotherapy demonstrate superior HRQoL benefits, monotherapy such as cetuximab is associated with significant improvements as compared to combination therapy. However, tailoring these results to individual gene expression profiles requires more evidence.
Revealing spatiotemporal inequalities, hotspots, and determinants in healthcare resource distribution: insights from hospital beds panel data in 2308 Chinese counties
Authors: Song Chao , Fang Lina , Xie Mingyu , Tang Zhangying , Zhang Yumeng , Tian Fan , Wang Xiuli , Lin Xiaojun , Liu Qiaolan , Xu Shixi , Pan Jay
Published: February 2024

Background

Ensuring universal health coverage and equitable access to health services requires a comprehensive understanding of spatiotemporal heterogeneity in healthcare resources, especially in small areas. The absence of a structured spatiotemporal evaluation framework in existing studies inspired us to propose a conceptual framework encompassing three perspectives: spatiotemporal inequalities, hotspots, and determinants.

Methods

To demonstrate our three-perspective conceptual framework, we employed three state-of-the-art methods and analyzed 10 years’ worth of Chinese county-level hospital bed data. First, we depicted spatial inequalities of hospital beds within provinces and their temporal inequalities through the spatial Gini coefficient. Next, we identified different types of spatiotemporal hotspots and coldspots at the county level using the emerging hot spot analysis (Getis-Ord Gi* statistics). Finally, we explored the spatiotemporally heterogeneous impacts of socioeconomic and environmental factors on hospital beds using the Bayesian spatiotemporally varying coefficients (STVC) model and quantified factors’ spatiotemporal explainable percentages with the spatiotemporal variance partitioning index (STVPI).

Results

Spatial inequalities map revealed significant disparities in hospital beds, with gradual improvements observed in 21 provinces over time. Seven types of hot and cold spots among 24.78% counties highlighted the persistent presence of the regional Matthew effect in both high- and low-level hospital bed counties. Socioeconomic factors contributed 36.85% (95% credible intervals [CIs]: 31.84–42.50%) of county-level hospital beds, while environmental factors accounted for 59.12% (53.80–63.83%). Factors’ space-scale variation explained 75.71% (68.94–81.55%), whereas time-scale variation contributed 20.25% (14.14–27.36%). Additionally, six factors (GDP, first industrial output, local general budget revenue, road, river, and slope) were identified as the spatiotemporal determinants, collectively explaining over 84% of the variations.

Conclusions

Three-perspective framework enables global policymakers and stakeholders to identify health services disparities at the micro-level, pinpoint regions needing targeted interventions, and create differentiated strategies aligned with their unique spatiotemporal determinants, significantly aiding in achieving sustainable healthcare development.
Fluid-solid coupling numerical simulation of the effects of different doses of verapamil on cancellous bone in type 2 diabetic rats
Authors: Wu Xiaodan , Gong He , Hu Xiaorong
Published: February 2024

Background

The purpose of this study was to investigate the effects of four different doses of verapamil on the mechanical behaviors of solid and the characteristics of fluid flow in cancellous bone of distal femur of type 2 diabetes rats under dynamic external load.

Methods

Based on the micro-CT images, the finite element models of cancellous bones and fluids at distal femurs of rats in control group, diabetes group, treatment groups VER 4, VER 12, VER 24, and VER 48 (verapamil doses of 4, 12, 24, and 48 mg/kg/day, respectively) were constructed. A sinusoidal time-varying displacement load with an amplitude of 0.8 μm and a period of 1s was applied to the upper surface of the solid region. Then, fluid-solid coupling numerical simulation method was used to analyze the magnitudes and distributions of von Mises stress, flow velocity, and fluid shear stress of cancellous bone models in each group.

Results

The results for mean values of von Mises stress, flow velocity and FSS (t = 0.25s) were as follows: their values in control group were lower than those in diabetes group; the three parameters varied with the dose of verapamil; in the four treatment groups, the values of VER 48 group were the lowest, they were the closest to control group, and they were smaller than diabetes group. Among the four treatment groups, VER 48 group had the highest proportion of the nodes with FSS = 1-3 Pa on the surface of cancellous bone, and more areas in VER 48 group were subjected to fluid shear stress of 1-3 Pa for more than half of the time.

Conclusion

It could be seen that among the four treatment groups, osteoblasts on the cancellous bone surface in the highest dose group (VER 48 group) were more easily activated by mechanical loading, and the treatment effect was the best. This study might help in understanding the mechanism of verapamil’s effect on the bone of type 2 diabetes mellitus, and provide theoretical guidance for the selection of verapamil dose in the clinical treatment of type 2 diabetes mellitus.
Incidence of dislocation and associated risk factors in patients with a femoral neck fracture operated with an uncemented hemiarthroplasty
Authors: Olesen Britt Aaen , Närhi Susanne Faurholt , Jensen Thomas Giver , Overgaard Søren , Palm Henrik , Sørensen Michala Skovlund
Published: February 2024

Background

Several factors might be associated with risk of dislocating following uncemented hemiarthroplasty (HA) due to femoral neck fracture (FNF). Current evidence is limited with great variance in reported incidence of dislocation (1–15%). Aim of this study was to identify the cumulative incidence of first-time dislocation following HA and to identify the associated risk factors.

Method

We performed a retrospective cohort study of patients receiving an HA (BFX Biomet stem, posterior approach) at Copenhagen University Hospital, Bispebjerg, in 2010–2016. Patients were followed until death or end of study (dec 2018). Dislocation was identified by code extraction from the Danish National Patient Registry.

Variables included in the multivariate model were defined pre-analysis to include: age, sex and variables with a p-value < 0.1 in univariate analysis. A regression model was fitted for 90 days dislocation as the assumption of proportional hazard rate (HR) was not met here after.

Results

We identified 772 stems (some patients occurred with both right and left hip) and 58 stems suffered 90 dislocations during the observation period, resulting in a 7% (CI 5–9) incidence of dislocation 90 days after index surgery. 55 of the 58 stems (95%) experienced the first dislocation within 90 days after surgery.

Only absence of dementia was identified as an independent protective factor in the cause-specific model (HR 0.46 (CI 0.23–0.89)) resulting in a 2.4-fold cumulative risk of experiencing a dislocation in case of dementia. Several other variables such as age, sex, various medical conditions, surgery delay and surgical experience were eliminated as statistical risk factors.

We found a decrease in survival probability for patients who experienced a dislocation during follow-up.

Conclusions

The incidence of first-time dislocation of HA (BFX Biomet stem, posterior approach) in patients with a hip fracture is found to be 7% 90 days after surgery. Due to the non-existing attribution bias, we claim it to be the true incidence. Dementia was among several variables identified as the only risk factor for dislocation.

In perspective, we may consider treating patients with dementia by other methods than HA e.g., HA with cement or with a more constrained solution. Also, a surgical approach that reduce the risk of dislocation should be considered.