bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on Dynamic Balance of Spindle Rotor System Based on Particle Swarm Optimization
Authors: Wang Zhan , Li Dongzheng , Wang Zinan , Liu Aoxiang , Tao Ruiyao
Published: December 2021

The dynamic balance is a significant issue for the nonlinear dynamic characteristics of the spindle rotor system. However, there is a problem that the dynamic balance is lacking detailed study on optimization method. In the paper, a modal dynamic balance optimization model of spindle rotor system is proposed, which can intend to improve the accuracy of spindle rotor system modal dynamic balance. Because the multiorder unbalance components are the main spindle rotor system mode shapes, the particle swarm optimization (PSO) method is adopted. The sum of squares of residual vibration after balancing is taken as the optimization objective, and the correction is presented as the optimization variable in the optimization model. The optimal correction weight of every unbalance component is calculated through a modal matrix equation of PSO. The vibration amplitude that is greatly reduced after optimization balance is presented under different conditions. The balancing effect shows a better dynamic characteristic than that of traditional methods. And the fluctuation range of the axis track of the rotor system also shows reductive phenomenon. The proposed optimization spindle rotor system model is well verified through experiments. It can contribute a theoretical optimization foundation for available dynamic balance in spindle rotor system.
45,X/46,XY Mosaicism with Male Phenotype: Case Report
Authors: Carreño-Martínez Angie Carolina , Mendoza Rojas Victor Clemente , Gil Forero Julian Arturo , Figueroa Victor Hugo , Contreras-García Gustavo Adolfo
Published: December 2021

Mixed gonadal dysgenesis is the most common chromosomal abnormality with ambiguous genitalia, defined as a 45,X/46,XY mosaicism. It can present with a normal male phenotype, ambiguous genitalia, or features of Turner syndrome. A 14-year-old patient was referred to the genetics clinic due to hypospadia, cryptorchidism, and aortic coarctation. During the physical examination, short stature, webbed neck, and Blashko lines on his back were noted. He had a previous karyotype reported as normal. However, due to an inadequate evolution and a low resolution on the previous test, a higher resolution karyotype was performed, identifying a mosaicism 45,X/46,XY. A multidisciplinary board examined the case, and follow-up with tumor markers was carried out to evaluate the presence of gonadoblastoma, one of the main complications in these patients. Treatment should be transdisciplinary and focused on the particular characteristics of each case. Other treatment alternatives include corrective surgery and hormonal therapy.
Efficacy of Endoscopic Posterior Nasal Neurectomy in Treating Eosinophilic Chronic Rhinosinusitis
Authors: Chen Manman , Xu Ming , Lei Xuefeng , Zhang Bin
Published: December 2021

Objectives: Recent guidelines have revealed that eosinophilic chronic rhinosinusitis (ECRS) exhibits a strong tendency for recurrence after surgery and impairs quality of life. Neuropeptides play an important neuroimmunological role. The aim of this study was to determine the efficacy of posterior nasal neurectomy (PNN) for the treatment of ECRS by inhibiting type 2 cytokine expression. Methods: Forty-six patients were divided into group A and group B according to a random number table. Group A underwent conventional functional endoscopic sinusitis surgery (FESS) combined with PNN, and group B underwent conventional FESS alone. The subjective and objective symptoms included a 10-cm visual analog scale (VAS), 22-item SinoNasal Outcome Test (SNOT-22) score, nasal speculum Lund-Kennedy score, and paranasal sinus computed tomography (CT) Lund-Mackay score at the 1-year postoperative follow-up. Results: Postoperative VAS (10.33 ± 2.18 vs. 8.38 ± 2.11, p < 0.01) and Lund-Kennedy score (1.95 ± 1.32 vs. 3.14 ± 1.35, p < 0.01) were significantly improved. The rhinorrhea score (1.76 ± 0.83 vs. 2.90 ± 1.14, p < 0.001) in the VAS and the discharge (0.43 ± 0.51, vs. 0.95 ± 0.67, p < 0.01) and edema (0.57 ± 0.60 vs. 0.95 ± 0.59, p < 0.05) scores in the Lund-Kennedy score were observed to have improved significantly in group A compared with those in group B. Conclusions: FESS combined with PNN suppresses edema symptoms, which might significantly decrease the surgical recurrence rate of ECRS in the long term.
Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest: A Systematic Review and Meta‐Analysis
Authors: Yeo Jun Wei , Ng Zi Hui Celeste , Goh Amelia Xin Chun , Gao Jocelyn Fangjiao , Liu Nan , Lam Shao Wei Sean , Chia Yew Woon , Perkins Gavin D. , Ong Marcus Eng Hock , Ho Andrew Fu Wah , Ang Shiang‐Hu , Chen Ruth Weixian , Chan Enoch Hin Kei , Goh Ee Ling , Ho Vui Kian , Lau Hong Khai , Lee Eng Kiang , Leong Benjamin Sieu‐Hon , Lim Jia Hao , Lim Shir Lynn , Loh Julian Kenrick Xingyuan , Ong Jimmy Heng Ann , Peck Kah Hua , Quek Daniel Yong Jing , Seet Christopher Ying Hao , Swarup Shobbit , Yong Thon Hon
Published: December 2021

Background

The role of cardiac arrest centers (CACs) in out‐of‐hospital cardiac arrest care systems is continuously evolving. Interpretation of existing literature is limited by heterogeneity in CAC characteristics and types of patients transported to CACs. This study assesses the impact of CACs on survival in out‐of‐hospital cardiac arrest according to varying definitions of CAC and prespecified subgroups.

Methods and Results

Electronic databases were searched from inception to March 9, 2021 for relevant studies. Centers were considered CACs if self‐declared by study authors and capable of relevant interventions. Main outcomes were survival and neurologically favorable survival at hospital discharge or 30 days. Meta‐analyses were performed for adjusted odds ratio (aOR) and crude odds ratios. Thirty‐six studies were analyzed. Survival with favorable neurological outcome significantly improved with treatment at CACs (aOR, 1.85 [95% CI, 1.52–2.26]), even when including high‐volume centers (aOR, 1.50 [95% CI, 1.18–1.91]) or including improved‐care centers (aOR, 2.13 [95% CI, 1.75–2.59]) as CACs. Survival significantly increased with treatment at CACs (aOR, 1.92 [95% CI, 1.59–2.32]), even when including high‐volume centers (aOR, 1.74 [95% CI, 1.38–2.18]) or when including improved‐care centers (aOR, 1.97 [95% CI, 1.71–2.26]) as CACs. The treatment effect was more pronounced among patients with shockable rhythm (
P
=0.006) and without prehospital return of spontaneous circulation (
P
=0.005). Conclusions were robust to sensitivity analyses, with no publication bias detected.

Conclusions

Care at CACs was associated with improved survival and neurological outcomes for patients with nontraumatic out‐of‐hospital cardiac arrest regardless of varying CAC definitions. Patients with shockable rhythms and those without prehospital return of spontaneous circulation benefited more from CACs. Evidence for bypassing hospitals or interhospital transfer remains inconclusive.
Numeral Classifiers in Udi: A Unique Contact-Induced Development among Nakh-Daghestanian?
Authors: Maisak Timur
Published: December 2021

Following Stilo’s (2018) study of small-inventory classifier systems in a number of Indo-European, Turkic, Kartvelian and Semitic languages of the Araxes-Iran Linguistic Area, the paper presents an account of numeral classifiers in Udi, a Nakh-Daghestanian (Lezgic) language spoken in northern Azerbaijan. Being a peripheral member of the linguistic area in question, Udi possesses an even more reduced version of a small-classifier system, comprising one optional classifier dänä (Iranian borrowing, most likely via Azerbaijani) used with both human and inanimate nouns. A dedicated classifier for humans is lacking, although there is a word tan (also of Iranian origin) only used after numerals or quantifiers, but predominantly as a noun phrase head. The behaviour of dänä and tan is scrutinized, according to a set of parameters, in both spoken and written textual corpora of the Nizh dialect of Udi. Drawing in the data from the related Nakh-Daghestanian languages, the paper shows that among the languages of the family Udi may be unique in possessing classifiers (albeit as a result of contact), Khinalug possibly being the only other exception.
Illustrated key to the genera included in the tribe Acanthocephalini (Hemiptera: Heteroptera: Coreidae: Coreinae), with descriptions of three new genera, seven new species, new taxonomic rearrangements, and a key to genera of Placoscelini
Authors: BRAILOVSKY HARRY
Published: December 2021

Three new genera and seven new species of Acanthocephalini Stål (Hemiptera: Heteroptera: Coreidae) are described: Anomalopetalops with three new species, A. brulei (French Guiana), A. ariquemesus (Brazil), and A. diamantinus (Brazil); Antipetalops with two new species, A. colombianus (Colombia), and A. discretus (Bolivia); and Cryptopetalops with two new species, C. llorentei (Brazil and French Guiana), and C. pluteus (Peru). Dorsal habitus photographs, and keys to the new species of each genus are added. Dorsal habitus photographs and a key to the 18 known genera of Acanthocephalini are given. Placophyllopus Blöte, 1938 is synonymized under Meluchopetalops Breddin, 1903. Placophyllopus cothurnatus Blöte, 1938 is considered a junior synonym of Meluchopetalops banausus Breddin, 1903. Bermejanus Brailovsky, 2018 is transferred to the tribe Placoscelini, and a key to the known genera of that tribe is provided.
Are Drug-Free School Zones Effective? Evidence From Matching Schools and School-like Entities
Authors: Freer Erica , Keefer Quinn
Published: December 2021

Using a combination of spatial and statistical analysis, this paper focuses on analyzing the effectiveness of drug-free school zones (DFSZ) around K-12 schools in Los Angeles County. A propensity score matching model is employed to match schools and school-like entities to compare the amount of drug crimes in two distinct 1000-foot buffers surrounding them. The model is then compared to a coarsened exact matching model. The average treatment effects (ATE) and average treatment effects on the treated (ATT) are estimated. Our results indicate that there are 2.7 and 1.7 fewer drug crimes and non–marijuana-related drug crimes respectively near schools, as a result of the policy. The total effect of the policy is estimated to reduce drug crime near schools by between 1065 to 1643 fewer incidences per year. Furthermore, we find no significant differences in gang-related drug crimes, gang-related violent crimes, or property crimes as a result of the policy.
Descriptive Characteristics of Nutrition Incentive Projects Across the U.S.: A Comparison Between Farm Direct and Brick and Mortar Settings
Authors: Parks Courtney A. , Mitchell Elise , Byker Shanks Carmen , Nugent Nadine B. , Fricke Hollyanne E. , Yaroch Amy L.
Published: December 2021

The purpose of this study is to describe the programmatic characteristics of current nutrition incentive projects supported by the Gus Schumacher Nutrition Incentive Program (GusNIP). Specifically, implementation characteristics of nutrition incentive projects that were funded in 2019 were compared across brick and mortar (B&M) and farm direct (FD) sites in the United States. Across 10 nutrition incentive (NI) grantees, there were 621 sites that reported data from B&M (n = 156) and FD (n = 465) locations. Among B&M sites, the common food retail types included: large chain traditional supermarket (n = 49) and independent traditional supermarket (n = 46). Among FD sites, the most frequently reported food retail types were farmers markets (n = 371). For B&M sites, the most common financial instruments were loyalty cards (n = 67, 43.5%), followed by an automatic discount at the register (n = 41, 26.6%), and coupons (n = 29, 18.8%). FD sites frequently reported physical financial instruments including tokens (n = 272, 61.1%), followed by paper vouchers (n = 131, 29.4%). Supplemental Nutrition Assistance Program (SNAP) purchases that were eligible to trigger incentives included mainly “all fresh FVs” at B&M sites (n = 98, 48.5%) and “all SNAP eligible items” at FD sites (n = 417, 85.8%). FVs eligible for incentive redemption included mainly “all fresh FVs” for both B&M sites (n = 110, 65.5%) and FD sites (n = 370, 67.6%). In terms of incentive-to-SNAP level ratio, both B&M sites and FD sites reported that they commonly utilized a 1:1 incentive-to-SNAP level ratio (n = 106, 68.8% and n = 261, 94.9% respectively). This paper will provide foundational understanding of the heterogeneity of GusNIP NI projects—specifically between B&M and FD settings—in order to inform future national work and ultimately demonstrate the impact of NI projects on food security status and dietary quality.
Monologue and Organization Studies
Authors: Izak Michal , Case Peter , Ybema Sierk
Published: December 2021

In this essay, we propose that recent work in management and organization studies is typically inclined to understand organization and organizing as dialogic in form. Dialogicity is characterized by dynamic interlocution on the part of active human sense-makers and, in our critical reading, evokes a romanticized social landscape that fails to reflect the more prosaic features of organizational life. To address what we see as certain limitations of the dialogic view, we introduce a complementary point of reference: that of monologic organization. This perspective provokes reflection on those situations in which meanings are predetermined at the outset and communication consists of the strictly controlled, routine reproduction of formal scripts. We draw on the works of Mikhail Bakhtin and Michel Serres to reclaim monologic as a pertinent view of organization and its processes. Finally, we provide micro-, meso- and macro-level examples to illustrate and discuss the heuristic potential of a monologic view.
Remote learning through a mobile application in gifted education
Authors: Tan Sema
Published: December 2021

During the school closure in the COVID-19 pandemic, students with special needs including gifted students faced many challenges in terms of educational support. The Turkish Ministry of National Education released a mobile app named “I am special, I am in education” to overcome these challenges. This study aimed to explore how gifted children perceived the experience of learning through this mobile app. Using a phenomenological design, the data were collected from 10 gifted students through focus group interviews and student journals. An inductive approach was used to analyze the data. The findings indicated that although gifted students referred to this experience as weird and different, they also stated that using the app helped their learning. They foregrounded that the app needed improvements and a section for live interaction with other gifted students and teachers to increase their motivation. This study suggests some implications for mobile app developers, educators, and parents.
Land grabbing and resistance of indigenous landowners in Ibadan, Nigeria
Authors: Obuene Henry Uche , Akanle Olayinka , Omobowale Ayokunle Olumuyiwa
Published: December 2021

The focus of existing studies on land grabbing in Nigeria has been on acquisition by foreign investors for their socio-economic gain, usually supported by the national government. However, narratives on land grabbing by government through the Land Use Decree and the consequent resistance deployed by the indigenous landowners are scarce. The Accumulation by Dispossession theory and an exploratory design were combined with qualitative methods to gather data from 41 participants through a combination of key informant and in-depth interviews and focus groups in Ajoda New Town. Data were ethnographically and content analysed and findings revealed that locals resisted government activities consequent upon their exclusion from compensatory and resettlement activities promised by the government. Displacement from patrimonial inheritance led to resistance, though government claimed it discharged its financial and moral responsibilities. Resistance took the form of violent, economic and civil protests.
Nora’s lesion of the distal ulna: a case report
Authors: Lin Cheng Han , Wu Karl
Published: December 2021

Nora’s lesion, also known as bizarre parosteal osteochondromatous proliferation (BPOP), is a very rare benign lesion with few published cases. BPOP is more common in adults during the second to third decades of life, and usually occurs on the hands and feet. Radiologically, it appears as a calcified mass attached to the bone cortex that grows rapidly and that recurs easily following resection. Aggressive features on imaging and confusing histopathological findings usually result in misdiagnosis or mistreatment. Herein, we present a case of a rare bony tumour involving the distal ulna presenting as a painless growing mass. An excisional biopsy with clear margins was performed without disturbing the ulnar nerve and arteries. There was no recurrent mass or calcified lesion 1 year after surgery. Based on its rarity and difficult diagnosis, BPOP should be considered in the differential diagnosis of a painless mass in the distal ulnar region. Careful follow-up after surgery is essential, even without lesion recurrence.
Testing Death Penalty Opinions With General Questions and A Specific Case Scenario: Potential Lessons From China
Authors: Liang Bin , Lu Hong , Liu Jianhong
Published: December 2021

Despite rich literature on public opinion on capital punishment, only a few studies examined people’s death penalty support within specific contexts. None have explored if correlates that influence people’s opinion would hold the same effect in general questions and specific case scenarios. Similarly, the Marshall hypotheses have not been tested with specific crime scenarios. Based on a sample of 1,077 students in a quasiexperimental design, this study contrasts Chinese students’ death penalty opinion in general questions with a specific crime scenario, and tests the Marshall hypotheses with the latter. Compared to their support in general questions, students’ support for death sentences dropped significantly in the specific crime scenario. Multivariate analyses showed that different factors influenced people’s decisions in the general questions and in the specific case, and respondents’ choices of preferred punishment in the specific crime scenario failed to lend support to the Marshall hypotheses.
Psychometric Assessment of the Paternal Breastfeeding Self-Efficacy Scale-Short Form: A Confirmatory Factor Analysis of Malawian Fathers
Authors: Chipojola Roselyn , Dennis Cindy-Lee , Kuo Shu-Yu
Published: December 2021

Background:

Only 61% of Malawian women exclusively breastfeed to the recommended 6 months. Paternal support is predictive of exclusive breastfeeding, and significantly related to paternal breastfeeding self-efficacy, defined as fathers’ confidence in their ability to assist mothers with breastfeeding.

Research Aims:

To (1) examine the psychometric properties of the Paternal Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) in Malawian fathers, including internal consistency reliability, test-retest reliability, construct validity using Confirmatory Factor Analysis (CFA), and convergent validity; and (2) assess the relationship between the BSES-SF and paternal demographic and health factors.

Methods:

A cross-sectional study was conducted at a maternity hospital in Lilongwe, Malawi, and 180 fathers whose partners had delivered a singleton infant were included. Participants completed the Breastfeeding Self-Efficacy Scale and Quality of Life with confirmatory factor analysis performed to assess the construct validity. The internal consistency reliability and test-retest reliability were evaluated using Cronbach’s alpha coefficient and intra-class correlations. Convergent validity was also assessed.

Results:

A unidimensional factorial structure of the Malawian Paternal BSES-SF was identified using confirmatory factor analysis. The scale had an excellent Cronbach’s alpha of .90 and a test-retest reliability of .93. Participants’ breastfeeding self-efficacy was significantly correlated with the Quality of Life domains of psychological health ( r = .23; p < .01), social relationships ( r = .28; p < .001), and environmental health ( r = .30; p < .001). Participants who were older, married, and with ≥ two children had significantly higher breastfeeding self-efficacy and were more confident in their ability to support their partner’s breastfeeding.

Conclusion:

The Paternal Breastfeeding Self-Efficacy Scale-Short Form was a valid and reliable measure to assess fathers’ confidence in their ability to assist mothers with breastfeeding in Malawi.
Belisario Domínguez: A life and death deserving of a medal
Authors: González-Abadía Alejandro , Graue-Hernández Enrique O. , Viesca-Treviño Carlos , Navas Alejandro
Published: December 2021

Belisario Domínguez was a Mexican physician, ophthalmologist, and politician. He traveled abroad to France, where he studied High School, later he entered the School of Medicine at Sorbonne University in Paris. Back in Mexico, Domínguez installed his medical office in his house. Belisario was recognized for his philanthropic attitude, he also often sought the well-being being of Chiapas and Mexico. In 1911 he became Comitán Municipal President, after the overthrown of presidente Porfirio Díaz.

He witnessed the coup against President Francisco Madero by General Huerta. Belisario wrote a speech in which he expressed the shame of having a traitor and murderer as President. As consequence of the speech, he was killed. After Belisario's assassination, an outrage was incited, damaging the image of President Huerta. Belisario's civic value was honored with a medal that bears his name “ Belisario Domínguez Medal” in 1953 which is the greatest recognition that can be obtained by a Mexican.
U.S. Women's Sport Consumption and Self-Identified Fandom: An Exploration of Social Structural and Sociocultural Antecedents
Authors: Sutton Frances S. , Knoester Chris
Published: December 2021

In this study, using data from the National Sports and Society Survey (N = 2853), we examine U.S. women’s reports of their sport consumption and self-identified sport fandom. Multiple regression analyses are used to assess associations between social structural and sociocultural antecedents of consumption and women’s frequencies of watching and following sport, frequencies of attending live sport events, and the amount of money that they spend to watch and follow sport. We then investigate the relationships between women’s sport consumption behaviors and their fandom. We find that women are common consumers of sport and their consumption is positively associated with their socioeconomic statuses, number of children, social relationships, sport participation experiences, and sport-related identities. We also find evidence that women’s sport consumption behaviors are only modestly associated with their levels of fandom. We conclude with reflections on what these results mean for better understanding and supporting women’s sport consumption and fandom.
Strategies to Prevent Elderly Suicide: A Delphi Consensus Study
Authors: Barak Yoram , Fortune Sarah , Hobbs Linda , Cheung Gary , Johari Nurrul , Zalsman Gil
Published: December 2021

Objectives

In the next decades, many countries will become ‘ageing societies’. This combined with the current high rates of suicide in later life suggests that many older adults may die by suicide before clinical trials can be conducted to demonstrate the best approaches to prevent late-life suicide.

Methods

A New Zealand (NZ) ‘expert panel’ has reviewed key considerations for suicide prevention interventions in older adults based on existing evidence, where available, and expert opinion. The key considerations were extracted from the current literature. The Delphi survey method was used to reach consensus for identifying interventions to be recommended as part of a national strategy for older adults’ suicide prevention.

Results

A set of 20 key recommended considerations are presented. The major addition to existing recommendations is the need for ‘A suicide prevention strategy for the elderly…’ to enhance the national all-ages suicide prevention strategy.

Conclusion

The recommended statements are offered for consideration by stakeholder groups preparing new interventions, large-scale public healthcare planning and governmental policy.
Multiscale modeling of ferroelectrics with stochastic grain size distribution
Authors: Lange Stephan , Ricoeur Andreas
Published: December 2021

Macroscopic properties of ferroelectrics are controlled by processes on the microscale, in particular the switching of crystal unit cells and the movement of domain walls, respectively. Besides these microscopic levels, the grains of a polycrystalline material constitute the mesoscopic scale. Interactions of grains with statistically distributed orientations, as a consequence of mechanical and electrostatic mismatch, give rise to for example, residual stress which in turn affects domain switching. A multiscale modeling thus has to incorporate at least three interacting scales. In this context, the condensed method has recently been elaborated as an efficient tool with low computational cost and effort of implementation. It is extended toward statistical distributions of grain sizes in a representative material volume element and amended with regard to the modeling of domain evolution. Each of the few parameters of the constitutive approach has a unique physical meaning and is adapted to available experimental values of macroscopic quantities of barium titanate taken from various sources.
“I thought that I had to be alive to repay my parents”: Filial piety as a risk and protective factor for suicidal behavior in a qualitative study of Chinese women
Authors: Lam June Sing Hong , Links Paul S. , Eynan Rahel , Shera Wes , Tsang A. Ka Tat , Law Samuel , Fung Wai Lun Alan , Zhang Xiaoqian , Liu Pozi , Zaheer Juveria
Published: December 2021

Filial piety involves the Confucian view that children always have a duty to be obedient and to provide care for their parents. Filial piety has been described as both a risk and a protective factor in depression and suicide. This qualitative study aimed to explore the role of filial piety in the suicidal behavior of Chinese women. Qualitative interviews were conducted with Chinese women with a history of suicidal behavior living in the Beijing area ( n = 29). Filial piety data were extracted and analyzed in accordance with constructivist grounded theory. The women described five specific family and filial piety factors and how they influenced their ability to fulfill family role obligations, which was described as a nexus connecting these factors to depression, suicidal behavior, and recovery. The five factors were: 1) rigidity of parental filial expectations, 2) perception of family relationships as positive/supportive or negative/harsh, 3) whether filial piety is of high or low personal value in the woman's life, 4) any experiences of rebellion leading to punitive consequences, and 5) how much filial piety she receives from her children. These factors could inform suicide risk assessments in this population. They can be harnessed as part of recovery and protect against future suicidal behavior.
Return to work: does cardiac rehabilitation make a difference? Danish nationwide register-based study
Authors: Pedersen Sasja Maria , Kruse Marie , Zwisler Ann Dorthe O. , Helmark Charlotte , Pedersen Susanne S. , Olsen Kim Rose
Published: December 2021

Aim:

to assess whether participation in cardiac rehabilitation affects the probability of returning to work after ischaemic heart disease.

Methods:

the study population consisted of 24,509 patients (18–70 years of age) discharged from an inpatient admission at a Danish hospital during 2014–2018 and who were working before their admission. Only patients with a percutaneous coronary intervention or coronary artery bypass grafting surgery procedure and ICD-10 codes I20–I25 as their main diagnosis or ICD-10 codes I21, I240, I248 or I249 as secondary diagnosis during an emergency admission were included. Exposure was defined as participation in cardiac rehabilitation ( N = 15,742), and binary indicator of being at work in the last week of a given month were used as primary outcomes. Coarsened exact matching (CEM) of exposed and unexposed patients was used to reduce selection bias. Logistic regression models were applied on the matched population ( N = 15,762).

Results:

Less deprived and less comorbid patients were more likely to receive cardiac rehabilitation. CEM succeeded in arriving at a population where this selection was reduced and in this population we found that patients who received cardiac rehabilitation had a lower probability of returning to work after 3 months (OR 0.81, 95%CI: 0.77–0.84), a higher but insignificant probability after 6 (OR 1.02, 95%CI: 0.97–1.08), and a higher probability after 9 (OR 1.08, 95%CI: 1.02–1.15) and 12 months (OR 1.20, 95%CI: 1.13–1.28).

Conclusions:

Deprived and comorbid patients have lower use of cardiac rehabilitation. In a matched population where this bias is reduced, cardiac rehabilitation will increase the probability of returning to work.
United or divided in diversity? The heterogeneous effects of ethnic diversity on European and national identities
Authors: Schraff Dominik , Sczepanski Ronja
Published: December 2021

In this article, we argue that the size and cultural proximity of immigrant populations in people's residential surroundings shape national and European identities. This means that the type of migrant population activates cultural threat perceptions and opportunities for contact to varying degrees. Geocoded survey data from the Netherlands suggests that large non-Western immigrant shares are associated with more exclusive national identities, while mixed contexts with Western and non-Western populations show more inclusive identities. These results suggest that highly diverse areas with mixed immigrant populations hold a potential for more tolerance. In contrast, exclusive national identities become strongly pronounced under the presence of sizeable culturally distant immigrant groups.
Audiovisual policy transfer between Mercosur and the European Union has gone offtrack
Authors: Fernandes Marina Rossato , Loisen Jan , Donders Karen
Published: December 2021

This article analyses the Audiovisual Mercosur Program as a case of policy transfer between Mercosur and the European Union. A qualitative document analysis, expert interviews and the use of policy transfer theory and its constraints made possible the critical evaluation of the program and its impacts. By focusing on the constraints that led to an incomplete and uninformed transfer, we were able to identify an alignment between the underlying ideas of audiovisual policies in Mercosur and the European Union, but also inadequate governance within Mercosur, unbalanced interests between the two trade blocks, and a lack of policy learning. As a result, the transfer of European Union policies reproduced well-documented failures of the European Union's internal market policies relating to the audiovisual sector.
Association between preconditioning absolute lymphocyte count and transplant outcomes in patients undergoing matched unrelated donor allogeneic hematopoietic stem cell transplantation with reduced-intensity conditioning and anti-thymocyte globulin
Authors: Seo Jeongmin , Shin Dong-Yeop , Koh Youngil , Kim Inho , Yoon Sung-Soo , Min Byun Ja , Hong Junshik
Published: December 2021

Background:

Allogeneic stem cell transplantation (alloSCT) offers cure chance for various hematologic malignancies, but graft- versus-host disease (GVHD) remains a major impediment. Anti-thymocyte globulin (ATG) is used for prophylactic T-cell depletion and GVHD prevention, but there are no clear guidelines for the optimal dosing of ATG. It is suspected that for patients with low absolute lymphocyte counts (ALCs), current weight-based dosing of ATG can be excessive, which can result in profound T-cell depletion and poor transplant outcome.

Methods:

The objective of the study is to evaluate the association of low preconditioning ALC with outcomes in patients undergoing matched unrelated donor (MUD) alloSCT with reduced-intensity conditioning (RIC) and ATG. We conducted a single-center retrospective longitudinal cohort study of acute leukemia and myelodysplastic syndrome patients over 18 years old undergoing alloSCT. In total, 64 patients were included and dichotomized into lower ALC and higher ALC groups with the cutoff of 500/μl on D-7.

Results:

Patients with preconditioning ALC <500/μl were associated with shorter overall survival (OS) and higher infectious mortality. The incidence of acute GVHD and moderate-severe chronic GVHD as well as relapse rates did not differ according to preconditioning ALC. In multivariate analyses, low preconditioning ALC was recognized as an independent adverse prognostic factor for OS.

Conclusion:

Patients with lower ALC are exposed to excessive dose of ATG, leading to profound T-cell depletion that results in higher infectious mortality and shorter OS. Our results call for the implementation of more creative dosing regimens for patients with low preconditioning ALC.
Building a Shared Mental Model of Competence Across the Continuum: Trainee Perceptions of Subinternships for Residency Preparation
Authors: Scheurer Johannah M. , Davey Cynthia , Pereira Anne G. , Olson Andrew P. J.
Published: December 2021

INTRODUCTION

Toward a vision of competency-based medical education (CBME) spanning the undergraduate to graduate medical education (GME) continuum, University of Minnesota Medical School (UMMS) developed the Subinternship in Critical Care (SICC) offered across specialties and sites. Explicit course objectives and assessments focus on internship preparedness, emphasizing direct observation of handovers (Core Entrustable Professional Activity, “EPA,” 8) and cross-cover duties (EPA 10).

METHODS

To evaluate students’ perceptions of the SICC's and other clerkships’ effectiveness toward internship preparedness, all 2016 and 2017 UMMS graduates in GME training ( n = 440) were surveyed regarding skill development and assessment among Core EPAs 1, 4, 6, 8, 9, 10. Analysis included descriptive statistics plus chi-squared and Kappa agreement tests.

RESULTS

Respondents ( n = 147, response rate 33%) rated the SICC as a rotation during which they gained most competence among EPAs both more (#4, 57% rated important; #8, 75%; #10, 70%) and less explicit (#6, 53%; #9, 69%) per rotation objectives. Assessments of EPA 8 (80% rated important) and 10 (76%) were frequently perceived as important toward residency preparedness. Agreement between importance of EPA development and assessment was moderate (Kappa = 0.40-0.59, all surveyed EPAs).

CONCLUSIONS

Graduates’ perceptions support the SICC's educational utility and assessments. Based on this and other insight from the SICC, the authors propose implications toward collectively envisioning the continuum of physician competency.
The role of multimodal imaging and vision function testing in ABCA4-related retinopathies and their relevance to future therapeutic interventions
Authors: Al-Khuzaei Saoud , Shah Mital , Foster Charlotte R. , Yu Jing , Broadgate Suzanne , Halford Stephanie , Downes Susan M.
Published: December 2021

The aim of this review article is to describe the specific features of Stargardt disease and ABCA4 retinopathies (ABCA4R) using multimodal imaging and functional testing and to highlight their relevance to potential therapeutic interventions. Standardised measures of tissue loss, tissue function and rate of change over time using formal structured deep phenotyping in Stargardt disease and ABCA4R are key in diagnosis, and prognosis as well as when selecting cohorts for therapeutic intervention. In addition, a meticulous documentation of natural history will be invaluable in the future to compare treated with untreated retinas. Despite the familiarity with the term Stargardt disease, this eponymous classification alone is unhelpful when evaluating ABCA4R, as the ABCA4 gene is associated with a number of phenotypes, and a range of severity. Multimodal imaging, psychophysical and electrophysiologic measurements are necessary in diagnosing and characterising these differing retinopathies. A wide range of retinal dystrophy phenotypes are seen in association with ABCA4 mutations. In this article, these will be referred to as ABCA4R. These different phenotypes and the existence of phenocopies present a significant challenge to the clinician. Careful phenotypic characterisation coupled with the genotype enables the clinician to provide an accurate diagnosis, associated inheritance pattern and information regarding prognosis and management. This is particularly relevant now for recruiting to therapeutic trials, and in the future when therapies become available. The importance of accurate genotype-phenotype correlation studies cannot be overemphasised. This approach together with segregation studies can be vital in the identification of causal mutations when variants in more than one gene are being considered as possible. In this article, we give an overview of the current imaging, psychophysical and electrophysiological investigations, as well as current therapeutic research trials for retinopathies associated with the ABCA4 gene.
Hepatitis B-related acute-on-chronic liver failure induced by hepatotropic viral insult is associated with worse prognosis than that induced by non-virus insult
Authors: Liang Jing , Liu Lei , Cao Yingying , Zhang Qian , Liu Fang , Chen Yu , Liu Hua , Duan Zhongping , Xu Manman , Xin Shaojie , You Shaoli , Song Fangjiao , Li Jun , Han Tao
Published: December 2021

Background

The manifestations and prognoses of acute-on-chronic liver failure (ACLF) with different precipitating events remain heterogeneous. We aimed to investigate the characteristics and prognosis of patients with hepatotropic viral insult (HVI)-induced hepatitis B-related ACLF (HBV-ACLF).

Methods

452 patients with confirmed diagnosis of ACLF were screened in three medical centers in China, and 203 HBV-ACLF patients with definite acute precipitating events were retrospectively analyzed. According to the precipitating events, HBV-ACLF patients induced by HBV reactivation and super-infection with HAV were classified as the hepatotropic viral insult group and those induced by other factors, as the non-virus insult (NVI) group. The clinical characteristics, predictive scoring model, and prognosis of the two groups were compared.

Results

Hepatitis B virus reactivation accounted for the largest proportion (39.9%) among all precipitating events. Exacerbation time frame of the HVI group was significantly longer than that of the NVI group (20 days vs. 10 days, P < 0.001). Comparison of intergroup prognosis showed that there was no significant difference in the 28 day mortality (20.9 vs. 13.7%, P = 0.125), while the 90 day and 1 year mortality in the HVI group were higher than those in the NVI group (36.3 vs. 24.4%, P = 0.014; 39.5% vs. 27.5%, P = 0.020, respectively). In the HVI group, the lactic acid-free APASL-ACLF Research Consortium (AARC) had better predictive value for 90 day mortality (0.741).

Conclusions

The 90 day and 1 year survival rate was lower in HBV-ACLF patients induced by HVI than by NVI. The lactate-free AARC score was a better predictor of short- and long-term prognosis in patients with HVI-induced HBV-ACLF.
Correlation between maternal eating disorder and early infant feeding regulation: a cross -sectional study
Authors: Rodgers Rachel F. , Hines Morgan , Martens Alaina , Zimmerman Emily
Published: December 2021

Background

The post-partum period is a vulnerable time for mothers in terms of eating disorder symptoms and is critical for the establishment of feeding patterns in infants. This study aimed to investigate the relationships between maternal eating disorder symptoms and objective indices of feeding regulation at 3 months, as well as perceived breastfeeding self-efficacy.

Methods

A sample ofn = 73 full-term mother-child dyads (44% female) participated in the study. Mothers self-reported eating disorder symptoms and breastfeeding self-efficacy and objective indices of infant feeding regulation were obtained in the home.

Results

Findings revealed the existence of relationships between higher maternal eating disorder symptoms, and objective indices of infant feeding regulation with substantial gender differences in the patterns emerging. Among mother-daughter dyads, maternal weight and shape concerns were associated with higher infant transfer volume and rate during bottle feeding. In contrast, among mother-son dyads, higher maternal eating disorder symptoms, including weight, shape, and eating concern, were associated with lower infant transfer volume and rate as well as lower levels of proficiency while taking their bottle.

Conclusion

Relationships emerged between higher maternal eating disorder symptoms and feeding regulation with substantial gender differences in these patterns. Additional research clarifying the underlying mechanisms of these associations is warranted and further efforts should be directed towards supporting mothers during the postpartum period.
Prevalence of BRCA1 and BRCA2 pathogenic sequence variants in ovarian cancer patients in the Gulf region: the PREDICT study
Authors: Azribi Fathi , Abdou Ehab , Dawoud Emad , Ashour Mohamed , Kamal Amgad , Al Sayed Mohamed , Burney Ikram
Published: December 2021

Background

Patients with pathogenic sequence variants (PSVs) in BRCA1/BRCA2 are at high risk of developing ovarian cancer (OC). However, genetic testing for BRCA1/BRCA2 PSVs is still not a routine practice in the Middle East. With the lack of epidemiological studies in the region, we aim to describe the prevalence of BRCA1/BRCA2 PSVs in patients with OC across different countries in the Gulf region.

Methods

The PREDICT study was an observational, prospective, epidemiological study, which consecutively recruited women with ovarian, primary peritoneal, and fallopian tube cancers from the following Gulf countries over the period from July 2017 to July 2019; United Arab Emirates (UAE), Kuwait, and Oman. The study was approved by the local ethics committee of participating centers. The BRCA1/BRCA2 PSVs were assessed by tissue genetic testing using next-generation sequencing (NGS).

Results

A total of 105 women were included with a median age at diagnosis of 52 years (IQR 44.5 – 61.0). Nearly 11.4% of patients reported a family history of ovarian or breast cancer, while 4.7% of patients reported a family history of other cancers. Most of the patients (70.3%) had advanced disease (FIGO stage III/IV) at presentation. Eighty-eight patients (84%) were successfully tested for somatic BRCA1/BRCA2 PSVs. Fifteen patients (17%) were found to have PSVs in either BRCA1, BRCA2, or both genes; of them, 10 patients (11.2%) had BRCA1 somatic PSVs alone, eight patients (9.1%) had BRCA2 somatic PSVs, while three patients (2.9%) had both PSVs. Five patients with BRCA1/BRCA2 somatic PSVs had germline PSVs tests, and three of them tested positive. Concerning treatment, 87.6% of patients received perioperative chemotherapy and 6.6% as first-line palliative chemotherapy. Eighty-seven (82.9%) patients underwent debulking surgery, with no residual disease in 42.5% of patients.

Conclusion

Our study showed that the prevalence of BRCA1/BRCA2 somatic PSVs in patients with OC is higher than the reported global figures (2-8%). However, more studies are warranted to further elucidate the prevalence of BRCA1/BRCA2 somatic and germline PSVs, as well as other relevant genetic alterations, to better understand their impact on OC patient outcomes in Gulf countries.

Trial registration

NCT03082976.
Explaining stress coping behaviors in patients with multiple sclerosis based on the PRECEDE model: a qualitative directed content analysis
Authors: Homayuni Atefeh , Hosseini Zahra , Abedini Sedigheh
Published: December 2021

Background

Stress can be regarded as one of the consequences of Multiple Sclerosis (MS) and a factor in exacerbating or recurring the symptoms resulting from the disease. This study aimed to explain the stress coping behaviors in patients with MS based on the PRECEDE model.

Methods

This study is a qualitative directed content analysis research based on the PRECEDE model. Data were obtained through in-depth semi-structured interviews with 26 patients with MS, who were selected using a purposive sampling and maximum diversity in terms of gender, age, education, marital status, and employment. Data collection continued until the saturation occurred. Simultaneously, collected data were analyzed using a qualitative directed content analysis method.

Results

Data analysis led to the identification of 11 sub-categories. Of these, 10 sub-categories were assigned to three categories of predisposing factors (awareness, attitude, self-efficacy, and perceived severity), enabling factors (existence of resources, access to resources, skills of using resources, and educational preferences), and reinforcing factors (social support, important others and behavioral consequences). The social comparison category was a new category identified from the analysis of interviews.

Conclusions

Based on the results, individual, environmental and social factors play a role in the stress of these patients. Designing programs that lead to their empowerment and improvements in the environmental and social conditions can be effective in controlling stress in these patients. Based on the results, planners can adopt the most appropriate strategies to change these determinants, help reduce stress, and promote the psychological standard of living in these patients.
Multimorbidity and tooth loss: the Brazilian National Health Survey, 2019
Authors: Bomfim Rafael Aiello , Cascaes Andreia Morales , de Oliveira Cesar
Published: December 2021

Background

Little is known about the presence of two or more chronic conditions (multimorbidity) on tooth loss between adults and older adults.Understanding the mechanisms of multimorbidity on tooth loss is essential to inform policy development. This study aims to investigate the association between multimorbidity and severity of tooth loss in Brazilian adults and older adults.

Methods

We analysed data from a nationally representative sample of 88,531 Brazilian individuals aged 18 and over who participated in the 2019 Brazilian Health Survey. Tooth loss was the outcome by two different classifications: functional dentition (lost 1–12 teeth) and severe tooth loss (lost 23–32 teeth). The presence of multimorbidity was the main exposure and based on 13 self-reported doctor-diagnosed chronic diseases that were further categorised into two groups, i.e., ≥2 or ≥ 3 comorbidities. Sociodemographic covariates included sex, age, race, income, level of education and tobacco smoking and geographic region of residency. Multivariate logistic regression models estimated the OR (Odds Ratios) and 95%CI of the associations between multimorbidity and tooth loss.

Results

For 65,803 adults (aged 18 to 59), the presence of multimorbidity (≥2) was associated with 32% higher odds of having severe tooth loss (95% CI, 1.17; 1.49) and 33% lower odds of having functional dentition (95% CI, 0.60; 0.75). For the 22,728 older adults (aged 60 and older), multimorbidity (≥2) was associated with a 17% higher odds of severe tooth loss (95% CI, 1.06; 1.29) and 23% lower odds of having functional dentition (95% CI 0.70; 0.85). The sensitivity analysis, excluding hypertension, confirmed our findings.

Conclusions

Brazilian adults and older adults with multimorbidity are more likely to have severe tooth loss and less likely to have functional dentition.