bluuebunny/crossref_metadata_2025 huggingface dataset:
Semi-empirical model of internal pressure for a high-speed train under the excitation of tunnel pressure waves
Authors: Chen Chun-jun , He Zhi-ying , Feng Yong-ping , Yang Lu
Published: September 2021

To study the transmission of air pressure from external to internal carriage of high-speed trains, an internal pressure model excited by tunnel pressure wave is established. Firstly, factors affecting the air pressure transmission are analysed. Then, the semi-empirical models of the internal pressure caused by a single factor are established based on both the theoretical analysis and experimental data: (1) by applying the finite element method, effects of carbody deformation are studied; (2) based on the static air tightness test, the transmission from the gaps is modelled and (3) the model of the air ducts are surveyed on the base of the characteristics of the ventilation fans and valves. Finally, three routes are comprehensively considered and a coupling model of the internal pressure is established. Simulation results shows the model is adaptable in predicting the internal pressure under excitation of tunnel pressure waves. Besides, the effect of the factors on internal pressure are studied based on the models. Among the factors, the deformation has the least effect. Meanwhile, the air ducts are the dominant factor that affects the internal pressure at high opening degree, while the gaps will become the dominant factor when the opening degree of air ducts is relatively low.
Cooch Behar: Medieval Regional History in a Bengal Frontierland
Authors: Adhikary Chanchal
Published: September 2021

For constructing the medieval political history of Cooch Behar, also known as Koch Bihar, the Persian manuscript of BahÂ ristÂ n-i-Ghaybī, discovered in 1919 by Jadunath Sarkar in the Bibliothèque Nationale of Paris, is very significant. This text facilitates our understanding of important historical events in eastern India during the time of Mughal Emperor Jahangir (1601–27). The text also provides important details of peasants’ revolts during the Mughal occupation, with remarkable implications until recent times regarding border relations between India and Bangladesh. The article examines the historical facts presented in this important text and corroborates them with other sources to argue that this text should be read as a chronicle for the history of warfare, society and peasants’ life in the region throughout the seventeenth century, with significant implications for later historical developments in Cooch Behar.
The Impact of COVID-19 on Small Businesses’ Performance and Innovation
Authors: Harel Ronen
Published: September 2021

This study looked at the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on the revenues of small businesses operating in industrial sectors and at the extent to which these businesses changed or adjusted their business activity, or changed the extent to which they utilized open innovation tools and implement innovation promotion processes. The findings show that, despite COVID-19’s far-reaching impact in all areas of life, the revenues of most small businesses in industrial sector were not adversely affected by the pandemic, and most of them did not change or adjust their business activities or the extent to which they employed open innovation tools and engage in innovation promotion processes. The findings also indicate that small businesses, most of whose revenues derive from subcontracting work to other businesses business to business (B2B) and from long-term agreements, are likely to cope better during periods of economic difficulty and under conditions of economic uncertainty. The findings also show that businesses that are active in the international markets have succeeded in adapting that activity to the changing demands and various trade restrictions. This study’s theoretical contribution lies in its focus on small businesses in the industrial sector and its examination of how the subcontracting strategy and international operations help such businesses contend with problems and conditions of economic uncertainty. On the practical plane, the findings suggest that policymakers should foster programmes that assist small businesses with these work strategies, which can help them survive, enhance their stability and thereby also promote the economy’s ability to withstand crisis situations
Expectations and Stock Market in Nepal
Authors: Sedhain Roshan , Shijin S.
Published: September 2021

This study examines the presence of both rational and adaptive expectations hypotheses in the Nepalese stock market by employing panel data analysis under the Fama–French three-factor model. Under the adaptive expectation hypothesis, the book to market equity is an essential determinant in the Nepalese stock market, and only the past 2-year information can explain investment decisions. Likewise, under the rational expectation hypothesis, the value factor, size factor and excess market return are important determinants during the investment decision. The past 3 years of information and the next 3 years of future information are necessary to estimate stock market return under rational expectation. Thus, this study reveals that the investment decision in the Nepalese stock market depends on the investor’s choice and preference upon the factors that are incorporated in the Fama–French three-factor model and the types of expectations in which the investors mostly believe.
Unusual Nasogastric Tube Position Leading to Delay in Diagnosis of Tracheoesophageal Fistula
Authors: Kaushal Monika , Asghar Saima , Kaushal Ayush
Published: September 2021

Aim:

This case highlights the importance of high index of suspicion for early diagnosis and thorough clinical examination of a newborn with tracheoesophageal atresia and fistula.

Case Report:

We report a case of most common type of tracheoesophageal atresia with fistula where diagnosis was missed due to unusual gastric position of nasogastric tube. Nasogastric tube reached stomach in esophageal atresia with fistula, delaying the diagnosis and management of condition. After accidental removal of tube and failure to pass again raised suspicion and was confirmed with coiled tube in esophageal pouch in X-Ray chest. Baby shifted to surgical unit for treatment, fortunately baby recovered and discharged home after surgical correction.

Conclusion:

Tracheoesophageal atresia with fistula can present with atypical symptoms and unusual events, challenging the early diagnosis and treatment of common types of conditions. Other association like VACTERL should be looked for, in patients.
Preparedness for Serious Illnesses: Impact of Ethnicity, Mistrust, Perceived Discrimination, and Health Communication
Authors: Bazargan Mohsen , Cobb Sharon , Assari Shervin , Bazargan-Hejazi Shahrzad
Published: September 2021

Background:

Increasing severity of serious illness requires individuals to prepare and make decisions to mitigate adverse consequences of their illness. In a racial and ethnically diverse sample, the current study examined preparedness for serious illness among adults in California.

Methods:

This cross-sectional study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. Participants included 542 non-Hispanic White (52%), non-Hispanic Black (28%), and Hispanic (20%) adults who reported at least one chronic medical condition that they perceived to be a serious illness. Race/ethnicity, socio-demographic factors, health status, discrimination, mistrust, and communication with provider were measured. To perform data analysis, we used logistic regression models.

Results:

Our findings revealed that 19%, 24%, and 34% of non-Hispanic White, non-Hispanic Blacks, and Hispanic believed they were not prepared if their medical condition gets worse, respectively. Over 60% indicated that their healthcare providers never engaged them in discussions of their feelings of fear, stress, or sadness related to their illnesses. Results of bivariate analyses showed that race/ethnicity was associated with serious illness preparedness. However, multivariate analysis uncovered that serious illness preparedness was only lower in the presence of medical mistrust in healthcare providers, perceived discrimination, less communication with providers, and poorer quality of self-rated health.

Conclusion:

This study draws attention to the need for healthcare systems and primary care providers to engage in effective discussions and education regarding serious illness preparedness with their patients, which can be beneficial for both individuals and family members and increase quality of care.
Longitudinal Trajectories and Correlates of Post-Caregiving Depressive Symptoms in Former Caregivers of Persons With Alzheimer’s Disease or a Related Dementia
Authors: Magan Kristin Corey , Hirschman Karen B. , Starr Lauren T. , Meghani Salimah H.
Published: September 2021

Background:

Despite the end of caregiving responsibilities, caregivers’ depressive symptoms continue following the death of the care recipient with Alzheimer’s disease or a related dementia (ADRD). However, long-term patterns of depressive symptoms among ADRD caregivers following the care recipient’s death remain poorly understood.

Purpose:

To explore longitudinal trajectories and correlates of depressive symptoms in former caregivers of persons with ADRD following the care recipient’s death.

Methods:

Using the modification of Cooper’s framework presented by Whittemore and Knafl, an integrative review was conducted in 4 stages: problem identification, literature search, data evaluation, and data analysis. The literature search was performed using CINAHL, PubMed, and PsycINFO databases. Articles were included if they were published in English between January 1994 and March 2021, reported in peer-reviewed sources, and described findings of original research related to factors, correlates, or longitudinal patterns of depressive symptoms in former family caregivers following the death of the care recipient with ADRD.

Results:

Longitudinal trajectories of depressive symptoms were categorized into 3 overarching themes: (1) gradual reduction of depressive symptoms during the first year post-caregiving; (2) failure of depressive symptoms to fully resolve after the first year post-caregiving; and (3) individualized depressive symptom trajectories. Correlates of post-caregiving depressive symptoms were categorized into 3 themes: (1) caregiver personal characteristics; (2) extrinsic factors; and (3) coping resources.

Conclusion:

These findings indicated that screening for depression and psychosocial support are high priorities during the first year post-caregiving to facilitate early identification of at-risk caregivers and improve mental health outcomes in this population.
Prediction and evaluation of fatigue life via modified energy method considering surface processing
Authors: Wang Haijie , Liu Xintian , Chen Tie , Xu Shen
Published: September 2021

To predict fatigue life more accurately, we consider the relationship between static toughness and fatigue toughness in fatigue failure process, the numerical model of total dissipated plastic strain energy (TDPSE) and fatigue life is established. And considering the effect of surface roughness and surface processing coefficient on fatigue life, the life prediction method of TDPSE is modified. In addition, the fatigue life of Non-Masing and Masing materials are predicted by TDPSE and modified TDPSE method, respectively. Compared with TDPSE method, the life estimated by the modified TDPSE method are closer to the test results, and the modified TDPSE method lays a technical foundation for the development of mechanical components.
Hope and Self-Compassion to Alleviate Parenting Stress in the Context of the COVID-19 Pandemic
Authors: Garcia Aileen S. , Born Staci L. , Carotta Christin L. , Lavender-Stott Erin S. , (Stella) Liu Hung-Ling
Published: September 2021

As the coronavirus disease of 2019 (COVID-19) pandemic disrupted all aspects of life, parents have been subjected to more household and caregiving responsibilities and stressors. The purpose of this study is to investigate how hope, self-compassion, and perception of COVID-19 health risks influence parenting stress. In this cross-sectional study, a total of 362 parents living in the United States completed an online survey in July 2020. Multiple regression analyses revealed that higher levels of hope are related to lower levels of parenting stress. On the other hand, lower levels of self-compassion as indicated by higher scores on the subscales of isolation, self-judgment, and overidentification are related to higher levels of parenting stress. Further, testing positive for the coronavirus is positively related to parenting stress, whereas the belief that COVID-19 is a serious disease is negatively related to parenting stress. Findings also revealed the significant role of hope in moderating the relation between self-compassion and parenting stress. This study highlights the importance of nurturing and drawing from one’s own psychological resources to mitigate parenting stress, particularly in the context of a chronic source of stress like a pandemic. Implications for the counseling profession are discussed.
Understanding donor preferences to optimise charity marketing and communications
Authors: Ferguson Kimberley
Published: September 2021

This case study explores how a leading charity, the British Heart Foundation (BHF), used research to ensure that the focus of its marketing and communications contributed to a story that people found engaging and were compelled to support. Amongst some staff, there was a view that the methodology of some of the BHF’s previous market research was not robust enough and that studies often lacked the quantitative data needed to develop marketing and communication strategies with confidence. Behavioural economics shows that there is usually a disconnect between what people say they will do and what they do in real life, the BHF wanted to develop a methodology that would interrogate this paradox. In doing so, it hoped to identify the areas of its work the public found most engaging and which would encourage people to support them. This insight would then be used to inform their new marketing communications plans. This note explains what the BHF learnt from involving explicit and implicit testing via a mix of qualitative and quantitative techniques.
The meanings of ‘child participation’ in international and European policies on children(’s rights): A content analysis
Authors: Montà Chiara Carla
Published: September 2021

The purpose of this paper is to explore the meanings of ‘child participation’ in international and European policy agendas on children(’s rights). The premise here is that policy agendas informed by children’s rights principles have the power to shape what a child can (learn) to do and be in a given society. Furthermore, the policy agendas analysed in this study are underpinned by pedagogical assumptions concerning the socio-cultural construction of childhood as a category and the spaces of participation that are dedicated and/or conceded to flesh-and-blood children. It is crucially important to explore the meanings of the ‘child-participation’ duo of terms as they are used in policy documents, because the values and principles thus conveyed constitute the political framework within which micro-pedagogical learning experiences, involving both children and adults, are constructed.
What are the ethical conflicts faced by Mexican internists?
Authors: Márquez Mendoza Octavio , Garduño García José de Jesús , Veytia López Marcela , Rodríguez García Jorge , García Peña Rosalía , Herreros Benjamin
Published: September 2021

Background

No studies have been conducted in Mexico to ascertain what ethical problems doctors working at hospitals deal with. This article aims to describe the ethical conflicts most commonly identified by Mexican internists and the importance they attribute to each of these conflicts.

Methods

Voluntary survey to the members of the Internal Medicine Association of Mexico.

Results

Responses were submitted by 347 internists. Half of those face ethical conflicts almost always or frequently. The most commonplace and relevant conflicts are those resulting from the clinical relationship (communication, confidentiality, informed consent, assessment of mental capacity, decisions involving incapacitated patients, and conflicts with family members), and secondly those problems related with the end of life (palliative care, withholding or withdrawing treatment, and “No CPR orders”). To resolve conflicts they seek support through protocols, Institutional Ethics Committees (IECs), and consultations with colleagues and, occasionally, with bioethics experts. Protocols and IECs are the tools most in demand among them.

Conclusions

1) the most frequent and relevant conflicts are those caused by the clinical relationship, above all those due to doctor–patient communication, and secondly those due to problems which arise at the end of life; 2) though nearly all of them have doubts about how to resolve conflicts, the vast majority are satisfied with the way in which they do so; 3) to deal with conflicts, they seek support mainly in protocols, IECs, and consultation with colleagues; and 4) in order to resolve them better, what they most demand are protocols and IECs, but also bioethics consultants.
Thermal aging behaviors of the waste tire rubber used in bitumen modification
Authors: Wang Haopeng , Liu Xueyan , Varveri Aikaterini , Zhang Hongzhi , Erkens Sandra , Skarpas Athanasios , Leng Zhen
Published: September 2021

Considering the application scenarios of rubber granules from waste tires in the bitumen modification process (wet or dry process), both aerobic and anaerobic aging of rubber may occur. The current study aims to investigate the thermal aging behavior of waste tire rubber samples using nanoindentation and environment scanning electron microscopy (ESEM) tests. Both aerobic and anaerobic aging tests with different durations were conducted on rubber samples. The complex moduli of aged rubber samples were measured by nanoindentation tests. The surface morphology and elemental composition of aged samples were obtained by ESEM tests together with the energy dispersive X-ray analysis. Results have shown that for both aerobic and anaerobic aging, the equilibrium modulus derived from the complex modulus curve first increases and then decreases with aging time. However, the time needed for the aerobically aged sample to reach the maximum equilibrium modulus is shorter than the anaerobic case. Aging results in crack propagation and an increase of sulfur content on the rubber surface until it reaches the peak. The degree of crosslinking reflected by sulfur content for anaerobic aging is higher than aerobic aging. The morphological change and elemental change of rubber correlate well with the change of mechanical properties. The aging of rubber from the waste truck tire at 180°C can generally be separated into two stages: crosslinking dominant stage and chain scission dominant stage.
Shapeless Listening to the More-Than-Human World: Coherence, Complexity, Mattering, Indifference
Authors: Behrisch Tanya J.
Published: September 2021

Through direct encounters with the more-than-human world (MTHW) I encounter otherness. Practices of oil painting, slowing down, shapeless listening, and gazing afford distinct ways of seeing that resist comprehension, naming, or control. This research affirms that much of the planet remains mysterious and likely indifferent to me. Respecting enduring mystery runs counter to empirical research doctrine, which through seeking to understand, quantify, and name, often entails destroying the source of wonder. Eschewing enclosure and control, I accept unknowability. Themes of coherence, complexity, mattering, and indifference emerge. This inquiry offers loose prescriptions for encountering otherness and invites researchers to practice humility.
Surgical Scheduling Impacts Hospital Length of Stay and Associated Healthcare Costs for Patients Undergoing Total Hip and Knee Arthroplasty
Authors: Ahsanuddin Sofia , Snyder Daniel J. , Huang Hsin-Hui , Keswani Aakash , Poeran Jashvant , Moucha Calin S.
Published: September 2021

Background:

Surgical scheduling, specifically the day of the week on which surgery is performed, has been associated with various postoperative outcomes in patients undergoing lower extremity joint arthroplasty.

Purpose:

We sought to investigate surgical scheduling as a potential modifiable factor for patient quality metrics and related costs.

Methods:

In a retrospective prognostic study, all total knee and total hip arthroplasty (TKA/THA) cases that took place in 2017 to 2018 at a multihospital academic health system were queried. Patients were separated by the day of the week the surgery was performed, with Monday/Tuesday compared to Thursday/Friday. Outcomes included length of stay (LOS) (extended LOS defined as 3 days or longer), cost, and complications. Multivariable regression models measured associations between scheduling of surgery and outcomes; odds ratios (OR) and 95% confidence intervals (CIs) are reported.

Results:

Overall, 1,571 TKA and 992 THA patients were included (65% and 35%, respectively, performed on Monday/Tuesday and 70% and 30%, respectively, performed on Thursday/Friday). Patients undergoing TKA on Monday/Tuesday versus Thursday/Friday had higher American Society of Anesthesiologists scores (42% vs 33% with score of 3 or higher) but less often an extended LOS (31% vs 54%; adjusted OR: 2.76, 95% CI: 2.22-3.46), lower skilled nursing facility costs (unadjusted mean, $12,515 vs $14,154) and lower home health aide costs (unadjusted mean, $3,793 vs $4,192). Similar patterns were observed in THA patients.

Conclusion:

These results from institutional data suggest that surgical scheduling is a modifiable factor possibly associated with postoperative outcomes. Furthermore, more rigorous study is warranted.
Perceiving the facial trustworthiness: Facial age, emotional expression, and attractiveness
Authors: Li Yongna , Chen Ziwei , Liu Xun , Qi Yue
Published: September 2021

People can make trustworthiness judgements based on facial characteristics. However, the previous findings regarding whether facial age influences interpersonal trust are inconsistent. Using the trust game, the current study investigated the interactions of facial age with attractiveness and emotional expression in regard to trustworthiness judgements. In Experiments 1 and 2, younger participants were asked to invest in either younger or older faces that were shown for 2,000 and 33 ms, respectively. The results showed that people trust the faces of older people more than they do younger people. There was also an interaction between facial age and attractiveness. Participants invested more money in older faces than in younger faces only when they perceived the faces to be less attractive. However, the interaction between facial age and emotional expression was slightly inconsistent in the two experiments. Participants invested more money in older faces that were shown for 2,000 ms when they perceived the happy and sad emotions, but they invested more money in older faces that were shown for 33 ms when they perceived the happy emotion. These results reveal that people make trustworthiness judgements based on multiple facial cues when they view strangers of different ages.
From Birth to Three: Exploring Educators’ Understandings of Agency
Authors: Burr Tanya , Degotardi Sheila
Published: September 2021

The Early Years Learning Framework promotes the need to recognise children’s participation rights and for educators to be responsive to and promote child agency. This study explored how infant and toddler educators understand agency, and what role they ascribe to themselves in infants’ and toddlers’ realisation of agency. Research was undertaken in early childhood settings in Brisbane, Australia. Interviews and reflection activities were conducted with 15 educators working with children under three years, and responses coded through thematic analysis. Participants provided some working definitions of agency and examples of supporting children’s agency in their everyday practices. However, responses largely revealed confusion and limited understandings of agency. Through engaging a critical feminist paradigm, a connection between the status provided to infant–toddler educators, and the impact upon their knowledge and practice is proposed, and recommendations put forward for increased opportunities relating to birth to three pedagogy.
The Influence of Physical Environmental Factors on Older Adults in Residential Care Facilities in Northeast China
Authors: Jingyi Mu , Shanshan Zhang , Wu Yue
Published: September 2021

Objectives:

To evaluate the aspects of the objective physical environments of five residential care facilities (RCFs) for older adults and the residents’ subjective perceptions of these aspects.

Background:

The physical environment in RCFs impacts the health and comfort of the residents. However, the design standards for RCFs lack details which can result in insufficient living conditions.

Methods:

Through questionnaire surveys, older adults’ satisfaction on the degree of the light, acoustic, and thermal environment in the facilities was obtained. Indoor lighting condition was measured by an illuminance meter in lux, sound pressure level (SPL) with sound level meters in dBA, and temperature in °C with a temperature data logger, and an audiometer was used to test the hearing of the older adults.

Results:

A total of 480 questionnaires were obtained. Results show that (a) older adults need an appropriate light environment to avoid the negative impact of limited light, (b) poor acoustic environment could affect their mood and health, and (c) when the room temperature is within the range of 20–26 °C (68–78.8 °F), they feel most comfortable. When the appropriate temperature and humidity, balanced illumination, and SPL meet the needs of older adults, it can provide a more comfortable physical environment for them.

Conclusion:

Examining the interaction between the physical environmental factors that affect older adults in RCFs is important for the design of residential housing and provides more theoretical support for research on the influence of the physical environment on the quality of life of older adults.
Therapeutic dilemmas regarding giant aneurysms of the intracranial vertebral artery causing medulla oblongata compression
Authors: Hou Kun , Qu Lai , Yu Jinlu
Published: September 2021

Background

Giant aneurysms of the intracranial vertebral artery are very rare cerebrovascular lesions. Due to the rarity of these aneurysms, we know little about them.

Methods

We performed a systematic review of the English literature by searching the PubMed database. The inclusion criteria were as follows: (a) the full text was available and (b) complete clinical data were available.

Results

A total of 45 articles were identified, containing 53 patients (53 aneurysms). The patients were aged from 5 to 77 years (48.8 ± 20.8 years). Four patients receiving conservative treatment died. The remaining 49 patients were divided into the aneurysm removal group ( n = 17) and the aneurysm reserve group ( n = 32). The outcomes of the 49 treated cases could be obtained in 45 cases, 31 of which (68.9%, 31/45) had a Glasgow outcome scale score of 4–5.

Conclusions

It is still difficult to treat intracranial giant vertebral artery aneurysms, regardless of the treatment selected. Because of the malignant natural history, aggressive treatment is still advocated.
Therapeutic approaches for non-alcoholic steatohepatitis
Authors: Van Gaal Luc F. , Mertens Jonathan , Francque Sven , De Block Christophe
Published: September 2021

Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) have been reported as a novel worldwide epidemic, very often associated with obesity, metabolic syndrome, and type 2 diabetes. Both conditions have also been shown to be associated with a number of endocrine pathologies. Despite the epidemic, the complex pathophysiology and major complications, ranging from metabolic disturbances (diabetes and more) to cardiovascular disease, people with NASH are left with very few management options. The best and most approved therapeutic option is lifestyle intervention.

Although pharmacotherapies based on pathophysiological background are in development, response rates appear modest, mainly for fibrosis treatment, which is the reason for lack of approved drug therapy. Previous drugs analyzed, such as pioglitazone and vitamin E, show weak efficacy. From different phase II trials, antidiabetic (injectable) drugs seem to be promising, both in mono- or bitherapy. Also, derivatives of peroxisome proliferator-activated receptors may have an interesting future, as well. For that reason, more focus should be given on prevention of this novel disease entity.

In view of this booming epidemic, with a background of obesity and type 2 diabetes, and the important medical consequences, early recognition, prevention and intervention of NAFLD/NASH seems appropriate. In this review, we will focus on the different current and future therapeutic intervention options, taking into consideration the complex pathophysiology of this disease.
Dyspnea after pulmonary embolism: a nation‐wide population‐based case–control study
Authors: Nilsson Lars T. , Andersson Therese , Larsen Flemming , Lang Irene M. , Liv Per , Söderberg Stefan
Published: September 2021

Dyspnea is common after a pulmonary embolism. Often, but not always, the dyspnea can be explained by pre‐existing comorbidities, and only rarely by chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH is probably the extreme manifestation of a far more common condition, called the post‐pulmonary embolism syndrome. The purpose of this retrospective study was to investigate the prevalence and predictors of dyspnea among Swedish patients that survived a pulmonary embolism, compared to the general population. All Swedish patients diagnosed with an acute pulmonary embolism in 2005 (n = 5793) were identified via the Swedish National Patient Registry. Patients that lived until 2007 (n = 3510) were invited to participate. Of these, 2105 patients responded to a questionnaire about dyspnea and comorbidities. Data from the general population (n = 1905) were acquired from the multinational MONItoring of trends and determinants in CArdiovascular disease health survey, conducted in 2004. Patients with pulmonary embolism had substantially higher prevalences of both exertional dyspnea (53.0% vs. 17.3%, odds ratio (OR): 5.40, 95% confidence intervals (CI): 4.61–6.32) and wake‐up dyspnea (12.0% vs. 1.7%, OR: 7.7, 95% CI: 5.28–11.23) compared to control subjects. These differences remained after adjustments and were most pronounced among younger patients. The increased risk for exertional dyspnea and wake‐up dyspnea remained after propensity score matching (OR (95% CI): 4.11 (3.14–5.38) and 3.44 (1.95–6.06), respectively). This population‐based, nation‐wide study demonstrated that self‐reported dyspnea was common among patients with previous pulmonary embolism. This finding suggested that a post‐pulmonary embolism syndrome might be present, which merits further investigation.
Cognitive impairment and pain relief following hip fractures: a case control study
Authors: Aftab Raiyyan , Dixit Divyansh , Williams Simon , Baker Laurence , Raindle Clarke David , Jack Christopher
Published: September 2021

Hip fractures represent a significant workload of both emergency and orthopaedic departments within the National Health Service (NHS). Pain relief is key in treating hip fractures as highlighted by both National Institute of Clinical Excellence (NICE) and British Orthopaedic Association Standards for Trauma (BOAST) guidelines. However, the literature shows that patients with cognitive impairment tend to have inconsistent pain management, leading to worse outcomes. We conducted a case–control study looking at 296 patients who presented with hip fractures to a major trauma centre between 1 December 2019 and 30 May 2020. Cognition was assessed using pre-recorded Abbreviated Mental Test Scores (AMTS). There was no significant difference between pain relief provided to patients with or without cognitive impairment in both the pre-hospital (p = 0.208) and Accident & Emergency (A&E) (p = 0.154) setting. A larger proportion of patients in A&E did not receive any pain relief (18.6% versus 42.2%). Pre-hospital, the higher the pain score, the stronger the analgesia given (R = 0.435, p = 0.000). This relationship was present in both the cognitively impaired (R = 0.572, p = 0.000) and cognitively intact groups (R = 0.390 p = 0.000). Strength of analgesia and pain scores did not correlate in A&E (R = 0.014, p = 0.826). Cognition did not impact the time to analgesia both pre-hospital (p = 0.291) and in A&E (p = 0.332); however, patients waited significantly longer to receive pain relief in A&E (29.61 minutes versus 150.28 minutes). Fascia-iliaca blocks were administered to 58.4% of the cohort, with no significant difference noted between cognition status. Overall, cognition does not impact pain management both pre-hospital and in A&E. There is still room for improvement, particularly in the assessment of pain in the cognitively impaired. A possible solution is the utilisation of the Bolton Pain Assessment Tool, a validated pain assessment tool for the cognitively impaired that has been utilised in the trauma setting with good effect.
The burden of serious fungal infections in Azerbaijan
Authors: Huseynov Ravil M. , Javadov Samir S. , Osmanov Ali , Khasiyev Shahin , Valiyeva Samira R. , Almammadova Esmira , Denning David W.
Published: September 2021

Background:

Azerbaijan is an upper middle-income country in South Caucasus with an area of 86,600 km2 and a total population of 10 million people and gross domestic product of US $4480 per capita. The aim of this research is to estimate fungal infection burden and highlight the problem at national and international levels.

Methods:

Fungal infection burden was estimated using data from epidemiological papers and population at risk and LIFE (Leading International Fungal Education) modelling.

Results:

The number of people living with human immunodeficiency virus (PLHIV) in 2018 was 6193, 29% of them not receiving antiretroviral therapy. Based on 90% and 20% rates of oral and oesophageal candidiasis in patients with CD4 cell count <200 µl–1 we estimate 808 and 579 patients with oral and oesophageal candidiasis, respectively. The annual incidences of cryptococcal meningitis and Pneumocystis pneumonia are 5 and 55 cases, respectively. We estimated 2307 cases of chronic pulmonary aspergillosis (CPA), 4927 patients with allergic bronchopulmonary aspergillosis (ABPA), and 6504 with severe asthma with fungal sensitization (SAFS). Using data on chronic obstructive pulmonary diseases (COPD), lung cancer, acute myeloid leukaemia rates, and number of transplantations, we estimated 693 cases of invasive aspergillosis following these conditions. Using a low-European rate for invasive candidiasis, we estimated 499 and 75 patients with candidemia and intra-abdominal candidiasis respectively. The number of adult women (15–55 years) in Azerbaijan is ~2,658,000, so it was estimated that 159,490 women suffer from recurrent vulvovaginal candidiasis (rVVC).

Discussion:

In total, the estimated number of people suffering from fungal diseases in Azerbaijan is 225,974 (2.3% of the population). However, the fungal rate is underestimated due to lack of epidemiological data. The most imminent need is improvement in diagnostic capabilities. This aim should be achieved via establishing a reference laboratory and equipping major clinical centers with essential diagnostics assays.
Loneliness and Mental Health: Recommendations for Primary Care Intakes
Authors: Godfrey Marissa , Liu Pi-Ju , Wang Aining , Wood Stacey
Published: September 2021

Introduction/Objectives

The healthcare intake process plays a significant role in informing medical personnel about patients’ demographic information, subjective health status, and health complaints. Intake forms can help providers personalize care to assist patients in getting proper referrals and treatment. Previous studies examined factors that could be included in intake forms independently, but this study analyzed loneliness, religiousness, household income, and social integration together to see how the combined effect influences mental and physical health status. This study aims to determine which of those 4 variables better inform patients’ mental versus physical health status.

Methods

One hundred and seventy-nine participants completed surveys, including the SF-12® Health Survey, measuring perceived physical and mental health, UCLA 3-item Loneliness Scale, and a demographics questionnaire with questions about household income and time spent dedicated to religious practice, if applicable. Additionally, individuals answered social integration questions about how often they contact close family and friends or volunteer in the community. Using loneliness, household income, religiousness, social integration as independent variables, and controlling for demographic variables such as age, gender, and race, 2 regression models were built with Mental and Physical Health Composite Scores from the the SF-12® Health Survey as dependent variables.

Results

Loneliness was associated with mental health measures ( b = −2.190, P < .001), while household income was associated with physical health measures ( b = 0.604, P = .019) above and beyond other variables in the regression models.

Conclusions

Integrating the 3 loneliness questions into intake forms can help approximate an individual’s mental health status. This would allow the provider to be able to assess mental health problems more effectively and provide needed resources.
Validation of an Assessment Tool to Measure Psycho-Social Factors Associated With Willingness to Participate in Child-Centered Initiatives
Authors: Ismail Ghouwa , Van Niekerk Ashley
Published: September 2021

The aim of the paper was the validation of a psychosocial assessment tool for determining willingness to participate in child-centered safety promotion interventions, specifically in a low-income community in South Africa. A study was conducted as part of the initial validation to test the items and format the questionnaire. The instrument was then administered to Afrikaans speaking individuals in a community in the Western Cape. Iterative exploratory factor analysis was conducted at both the item and scale levels to select and reassign items and scales to determine the final composition of the questionnaire. The findings indicate that the instrument measures seven factors, namely incentives; priorities and community needs; perceived benefits; social approval; accessibility and values; altruistic capital; and community cohesion, which represents salient dimensions of the construct willingness to participate in interventions. The questionnaire and its subscales displayed acceptable to good reliability, with Cronbach’s α ranging from .55 to .80. Since willingness precedes actual participation, it is argued that insight into the factors that relate to willingness to participate provides an avenue for motivating actual participation.
Framework of Goal-driven Risk Management in Software Development Projects Using the Socio-technical Systems Approach
Authors: Singh Nimisha
Published: September 2021

Previous studies have identified the influence of goal agreement on requirement elicitation in software projects, but they have not addressed how it influences risks in projects. The purpose of this study is to examine the influence of goal identification and agreement on software project risks. With socio-technical systems theory as the backdrop, we used a goal-oriented perspective to understand how the social subsystem influences the technical subsystem of a software development project. In an empirical study with 411 responses from software project developers and managers in India and using structural equation modelling, the causal linkages between goal orientation and project risk variables have been examined. The results indicated that the early adoption of goal-driven risk management reduces the social context risks which, in turn, reduces the project management risk. The study also revealed that the product artefact is independent of whether the system was completed within budget and schedule. To design the risk management strategy, project managers should consider the relationship between social context risk and project management risk and the implications of these relationships on project performance.
Acute Kidney Injury and Jaundice in a Patient With Concurrent Severe Malaria and Acute Exacerbation of Hepatitis B
Authors: Jonny Jonny , Violetta Laurencia
Published: September 2021

Patients chronically infected with hepatitis B virus (HBV) may travel to areas with high endemicity of malaria. The overlap between malaria and HBV infection can be clinically severe and present a diagnostic challenge as both diseases manifest similar symptoms. This case describes a fatal case of a 43-year-old man with chronic HBV infected with Plasmodium falciparum malaria that presents as acute kidney injury (AKI) and jaundice following a trip to malaria-endemic region. Despite administering antimalarial and 6 courses of renal replacement therapy, the patient’s clinical condition did not improve, leading to septic shock, multi-organ dysfunction, and eventually, death. AKI and jaundice are commonly seen in severe P. falciparum malaria, as well as acute exacerbation of chronic HBV. This case emphasizes the importance to consider malarial screening when evaluating sick returning travelers, even in those with underlying chronic HBV. Given the severity of coinfection, prompt identification of this overlap can avert the rapid deterioration of severe malaria by early administration of intravenous artesunate and renal replacement therapy.
The Lived Experience of Continuous Subcutaneous Insulin Infusion in Adults With Type 1 Diabetes Mellitus: A Phenomenological Inquiry
Authors: Callahan Fagan V. Renee , Parsons Karen
Published: September 2021

Continuous subcutaneous insulin infusion (CSII) is a complex, medical device for the management of Type 1 Diabetes Mellitus (T1DM). There is limited research exploring the everyday experiences living with this device. The purpose of this study was to understand the lived experience of adults using CSII therapy to manage T1DM. Lived experiences from eight individuals were collected through semi-structured interviews and then analyzed using a hermeneutic approach to phenomenology. Four substantive themes with supporting subthemes were identified and represent the essence of participant experiences; that is, living with CSII eventually took ascendancy over managing T1DM.CSII therapy has gained popularity due to reported improvements in metabolic control and flexibility. However, the burden of the responsibility and psychological implications of CSII took ascendancy over T1DM. Living with CSII impacts the psychological well-being of individuals so psychological complications are as important to assess by healthcare professionals as physical and metabolic complications.
European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia
Authors: Dziewas Rainer , Michou Emilia , Trapl-Grundschober Michaela , Lal Avtar , Arsava Ethem Murat , Bath Philip M , Clavé Pere , Glahn Jörg , Hamdy Shaheen , Pownall Sue , Schindler Antonio , Walshe Margaret , Wirth Rainer , Wright David , Verin Eric
Published: September 2021

Post-stroke dysphagia (PSD) is present in more than 50% of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and to early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioural swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomized trials are needed to improve the quality of evidence for the treatment of PSD.
European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment
Authors: Quinn Terence J , Richard Edo , Teuschl Yvonne , Gattringer Thomas , Hafdi Melanie , O’Brien John T , Merriman Niamh , Gillebert Celine , Huyglier Hanne , Verdelho Ana , Schmidt Reinhold , Ghaziani Emma , Forchammer Hysse , Pendlebury Sarah T , Bruffaerts Rose , Mijajlovic Milija , Drozdowska Bogna A , Ball Emily , Markus Hugh S
Published: September 2021

The optimal management of post-stroke cognitive impairment remains controversial. These joint European Stroke Organisation (ESO) and European Academy of Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making around prevention, diagnosis, treatment and prognosis. These guidelines were developed according to ESO standard operating procedure and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and, where possible, meta-analyses of the literature, assessed the quality of the available evidence and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. There was limited randomised controlled trial evidence regarding single or multicomponent interventions to prevent post-stroke cognitive decline. Interventions to improve lifestyle and treat vascular risk factors may have many health benefits but a beneficial effect on cognition is not proven. We found no evidence around routine cognitive screening following stroke but recognise the importance of targeted cognitive assessment. We described the accuracy of various cognitive screening tests but found no clearly superior approach to testing. There was insufficient evidence to make a recommendation for use of cholinesterase inhibitors, memantine nootropics or cognitive rehabilitation. There was limited evidence on the use of prediction tools for post-stroke cognitive syndromes (cognitive impairment, dementia and delirium). The association between post-stroke cognitive impairment and most acute structural brain imaging features was unclear, although the presence of substantial white matter hyperintensities of presumed vascular origin on acute MRI brain may help predict cognitive outcomes. These guidelines have highlighted fundamental areas where robust evidence is lacking. Further, definitive randomised controlled trials are needed, and we suggest priority areas for future research.