bluuebunny/crossref_metadata_2025 huggingface dataset:
Going global: The influence of transformative experience on social entrepreneurial decisions to internationalize
Authors: Ascencio Christine , Benmamoun Mamoun , Alhorr Hadi
Published: August 2022

Despite increased importance of SEs in the global marketplace, limited research in social entrepreneurship addresses internationalization, and fewer from a behavioural perspective. We fill this gap by investigating the SE manager’s behavioural attributes and their influence on the decision of social entrepreneurs to become international social entrepreneurs (ISEs) through an exploratory design using content analysis and interviews. All social entrepreneurs were driven to address social change by a strong social conscience; however, this research finds that ISEs shared an urgent and personal call to action. This sense of urgency developed from transformative experiences that altered their views of the world and their place within it. Domestic social entrepreneurs were motivated primarily by their social conscience, shared background, and the timing of the social enterprise opportunity, factors previously identified in research.
The implementation of artificial intelligence significantly reduces door-in-door-out times in a primary care center prior to transfer
Authors: Hassan Ameer E. , Ringheanu Victor M. , Tekle Wondwossen G.
Published: August 2022

Introduction

Viz LVO artificial intelligence (AI) software utilizes AI-powered large vessel occlusion (LVO) detection technology which automatically identifies suspected LVO through CT angiogram (CTA) imaging and alerts on-call stroke teams. This analysis was performed to determine whether AI software can reduce the door-in-door-out (DIDO) time interval within the primary care center (PSC) prior to transfer to the comprehensive care center (CSC).

Methods

We compared the DIDO time interval for all LVO transfer patients from a single-spoke PSC to our CSC prior to (February 2017 to November 2018) and after (November 2018 to June 2020) incorporating AI. Using a stroke database at a CSC, demographics, DIDO time at PSC, modified Rankin Scale (mRS) at 90-days, mortality rate at discharge, length of stay (LOS), and intracranial hemorrhage rates were examined.

Results

There were a total of 63 patients during the study period (average age 69.99 ± 13.72, 55.56% female). We analyzed 28 patients pre-AI (average age 71.64 ± 12.28, 46.4% female), and 35 patients post-AI (average age 68.67 ± 14.88, 62.9% female). After implementing the AI software, the mean DIDO time interval within the PSC significantly improved by 102.3 min (226.7 versus 124.4 min; p = 0.0374).

Conclusion

The incorporation of the AI software was associated with a significant improvement in DIDO times within the PSC as well as CTA to door-out time in the PSC. More extensive studies are warranted to expand on the ability of AI technology to improve transfer times and outcomes for LVO patients.
Management of WEB device migration and mal-position in endovascular treatment of cerebral aneurysms
Authors: Gravino Gilbert , Masri Souhyb , Chandran Arun , Puthuran Mani
Published: August 2022

With increasing advances in technology, the breadth of aneurysms that are treatable via an endovascular approach has increased. Wide necked aneurysms remain difficult to treat but the emergence of dedicated intrasaccular flow disruption devices such as the Woven EndoBridge (WEB, Micorvention) has increasingly seen previously ruptured and unruptured wide necked aneurysms successfully embolised and secured from the circulation using a single device.

We are reporting two cases of WEB device treatment from the earliest experience with this device at our institution. These were complicated by partial extrusion in one case and remote migration of the WEB device in another case. Our initial cases highlight the importance of case selection and the need for accurate WEB sizing which are paramount to ensure complete occlusion of the aneurysm without complications of dislocation or extrusion into the parent vessel. Since then, we have performed over 170 cases with the WEB device. We also present a comprehensive review of the limited literature available on the management of mal-positioned and dislocated WEB devices. This allows us to reflect on how to avoid these complications and the different management options at the disposal of the neuro-interventionalist once such a complication has already occured. Rescue devices and manoeuvres that we reflect on include microcatheter manipulation, alligator retrieval device, stent retrievers, microsnares, aspiration, and stenting. Ultimately, each case needs to be individually evaluated and the best strategy selected depends on the context and specific circumstances.
A discrete-time linear model predictive control for motion planning of an autonomous vehicle with adaptive cruise control and obstacle overtaking
Authors: Seo Ji Hwan , Kwon Seong Kyung , Kim Kyoung-Dae
Published: August 2022

Motion planners for autonomous driving improve traffic safety through collision-free motion generation along the path. However, conventional motion planners render passengers uncomfortable as a result of jerky motion. To overcome this, we propose a model predictive control (MPC) based motion planner that not only ensures safety but also improves driving comfort. The proposed planner generates path tracking and collision-free maneuvers to ensure safety, and improve driving comfort by minimizing acceleration and jerk. Collision-free maneuvers include vehicle following and overtaking. The target speed is determined by comprehensively considering path tracking performance improvement and whether overtaking is possible. The speed of the vehicle is controlled by considering longitudinal acceleration and jerk minimization. The steering command is determined by considering both path tracking error reduction, and lateral acceleration and jerk minimization. In cases where vehicle overtaking is required and during high-speed driving conditions, the consideration of lateral acceleration and jerk minimization increases to improve driving comfort. The proposed planner is formulated as a convex optimization problem. The effectiveness of the proposed planner was evaluated in path tracking and collision avoidance simulations. The simulation results confirm that the proposed planner ensures vehicle safety through lane keeping and collision avoidance, and improves driving comfort.
The association between mean platelet volume and poor outcome in patients with COVID-19: Systematic review, meta-analysis, and meta-regression
Authors: Zein Ahmad Fariz Malvi Zamzam , Sulistiyana Catur Setiya , Raffaelo Wilson Matthew , Pranata Raymond
Published: August 2022

Introduction:

This study aims to assess the association between mean platelet volume (MPV) and poor outcome in patients with COVID-19.

Methods:

We performed a comprehensive literature search using the PubMed, Embase and Scopus databases with keywords “2019-nCoV” OR “SARS-CoV-2” OR “COVID-19” AND “mean platelet volume” OR “MPV” on 8 July 2021. The primary outcome was composite poor outcome, defined as severe COVID-19 or mortality. The pooled effect estimate was reported as mean differences in terms of MPV between the group with and without outcome.

Results:

There were 17 studies which consist of 4549 patients with COVID-19 were included in this study. The incidence of poor outcome was 25% (20%–30%). Mean MPV was found to be higher in the poor outcome group in compare to no poor outcome group (10.3 ± 1.9 fL vs 9.9 ± 1.7 fL). The mean MPV difference between both group was 0.47 fL [95% CI 0.27, 0.67], p < 0.001; I2: 62.91%, p < 0.001). In the sub-group analysis, patients with severe COVID-19 had higher MPV (mean difference 0.54 fL [95% CI 0.28, 0.80], p < 0.001; I2: 54.84%, p = 0.014). Furthermore, MPV was also higher in the mortality group (mean difference 0.54 fL [95% CI 0.29, 0.80], p = 0.020; I2: 71.11%, p = 0.004). Meta-regression analysis showed that the association between MPV and poor outcome was not affected by age ( p = 0.789), gender ( p = 0.167), platelets ( p = 0.056), white blood cells ( p = 0.639), and lymphocytes ( p = 0.733).

Conclusion:

This meta-analysis indicated that increased MPV was associated with severity and mortality in patients with COVID-19. Further research is needed to determine the optimum cut-off point.
Reimagining the Personal Network: The Case of Path
Authors: Bayer Joseph B. , Sweitzer Matthew D. , Xiang Haoyan , Mohan Sriram , Myers Ellen
Published: August 2022

The rise of highly curated networks is a pivotal dimension of social media history, yet its diverse origins remain overlooked. Here, two inductive studies investigated the case of Path: a platform (2010–2019) designed around so-called “Dunbar’s Numbers” and core networks (i.e., close friends). Study 1 conducted manual and automated text analyses using App Store archives via the Wayback Machine to evaluate changes in the industry presentation over time. Analyses showed how Path placed consistent emphasis on its ability to reinforce close ties and provide a curation-centered version of authenticity. Study 2 analyzed how users and commenters discussed Path over the same period via topic modeling of a Twitter corpus, revealing the centrality of rise-and-fall narratives to conversation about the platform. Together, the studies displayed how Path’s growth foretold changes in the social media ecosystem and how online conversation diverged from industry logics. To conclude, we discuss how Path’s history parallels theories on personal network changes, including the importance of user-driven versus algorithm-driven curation. To that end, we showcase the potential (and challenges) of using digital traces to uncover the evolution of platforms from the perspectives of different stakeholders.
Prediction of debt crisis in Southern African Development Community (SADC)
Authors: Chirume Crispen
Published: August 2022

Debt levels in the Southern African Development Community (SADC) have been rising over the years as countries undertake infrastructure projects and the increased use of bilateral and private credit. Although on aggregate the debt levels are within SADC recommendations on macroeconomic convergence, there are growing fears that a number of countries in the region might default and indeed some are already in default. The frequent occurrence of debt crisis is a cause for concern. This research is an attempt to determine the significant predictors from a small set of variables commonly touted as important in debt crisis prediction. The research considered the output gap, real exchange rate, external debt ratios, commodity shocks and quality of governance as potential predictors. The factor variables being of particular interest Empirical findings on these potential predictors is somehow mixed, which partly is accounted for by the differences in model specifications from author to author. The research employed the event study and fixed effects logistic regression for modelling the probability of default of public debt. Results of the model illustrate that governance indicators and commodity price shocks (global level) were not statistically significant predictors of debt crisis as commonly suggested by theory. However the external debt, output and the real foreign exchange rate were all significant. Real output was shown to be one of the most important predictors of debt crisis. The estimated probability model fared relatively better than a random model.
Study of Iran–Saudi Arabia Sports Relations
Authors: Mohsenifar Ali , Dousti Morteza , Zare Fateme , Géczi Gábor
Published: August 2022

Political tensions and conflicts have been accompanying modern sports for a long time. The objective of this study was to determine the political reasons for not hosting football matches between Iranian and Saudi football teams. To address the research objective, a mixed-method approach was used. First, in the qualitative part, the political reasons for not hosting the matches identified through the content analysis and interviews were reviewed and evaluated by Delphi Group (25 people) in the second and third stages. Secondly, in the qualitative section of the study, the questionnaire was also used to rank the reasons. The research findings showed that tensions between Tehran and Riyadh increased after the Saudi Embassy attack in Tehran and Mashhad (January 2016) and the execution of Sheikh Nimr, a Shia sheikh opposed to the Saudi government. Saudi Arabia has requested that the Asian Champions League matches against Iranian opponents be held on neutral grounds in order to ensure the safety of its players. It is therefore recommended that sports managers and politicians in Iran reduce the political tensions between the two countries. In addition, they need to strive toward creating peace, friendship, and security between the two countries.
Disrupting Caste Hegemony in Punjab: A Reading of the Punjabi Dalit Poetry of the Pre-Independence Period
Authors: Kaur Ravinder
Published: August 2022

The idea of caste has always been debatable, contested and controversial. Since the time of its inception, it has been prevalent throughout India. Any Indian cannot define his or her identity without referring to his or her caste. However, it also became and still is a reason behind the marginalization and exploitation of millions of people. Various activists, scholars, thinkers, political leaders and literary writers have tried to fight against the stigmatization of a particular caste. However, the experience of caste discrimination is not the same in all the states of India. Though the basic problems and concerns of Dalits such as untouchability and exploitation are the same, their degree and intensity vary from one state to another. Various cultural, social and economic moorings impact the way caste-based discrimination is practised in a particular society. Various critics from Punjab such as Ronki Ram, Harish Puri and Paramjit Judge argue that the experience of Dalits in Punjab is comparatively different than those in other parts of India because in Punjab casteism was practised not on the basis of purity/pollution syndrome but as a divide between the landless and the land-owning communities, so they have studied the material aspect of caste. It is observed that the literary writings by Dalits from Punjab highlight instances of untouchability and caste-based discrimination in the pre- and post-independence periods. They resisted and protested against the caste system and also claimed to overthrow it. Therefore, the article seeks to evaluate the notion of casteless in Punjab. It takes into account the poetry of Gurdas Ram Alam, Charan Das Nidharak and Pritam Ramdaspuri. Through the qualitative content analysis using theories of Dalit aesthetics, the article explores the major thrust areas of Punjabi Dalit poets and highlights how these poets express their caste identity and try to raise the consciousness of their fellow caste members and protest against the discriminatory practices of the dominant Punjabi society and culture. It also, in a way, makes these poets (and those communities to which they belong) a subcultural phenomenon that runs parallel to the dominant Jatt culture of Punjab.
Sustaining Community-Based Responses to the COVID-19 Pandemic: Learning Platforms at Work in Freetown, Sierra Leone
Authors: Koroma Braima , Macarthy Joseph Mustapha , Conteh Abu , Osuteye Emmanuel
Published: August 2022

In Freetown, Sierra Leone, despite the progress in the official response to the COVID-19 outbreak, there remain concerns about the limited involvement of local communities and the use of bottom-up participatory approaches in the response. While the official response has been characterised by restrictive public health measures such as partial lockdowns and the declaration of a state of a public health emergency, for the urban poor, the implications have been wide-ranging including the deepening of inequalities, especially among residents in slum-like informal settlements who already suffer from pre-COVID-19 structural challenges and vulnerabilities. This includes challenges linked to health systems fragility, environmental risks and uncertainties around livelihoods in the informal economy, which forces many to live from hand to mouth. Ultimately, these vulnerabilities challenge the acceptance and compliance of the restrictive state-led health measures, which puts them at risk of infections. To address these structural inequalities and foster an inclusive dialogue, a City Learning Platform, comprising the Freetown City Council, local community residents and their groups, and a few non-governmental organisations have been working creatively to respond to the COVID-19 challenges faced by the urban poor. But, while this alternative bottom-up approach has allowed the coordination of response to address community-level priorities more effectively, how well the platform has been able to successfully sustain the interest and commitments of vulnerable groups and to build their capacities, co-create knowledge and explore new opportunities has yet to be understood. This article highlights the strategic value of Community Learning Platforms in sustaining local responses to the pandemic. It also explores how social protection measures are shaped into the local response and help tackle deeply entrenched inequalities in the communities. The article additionally reflects on the challenges and opportunities for using the Community Learning Platforms in the COVID-19 response.
Investigation of the Mechanical Properties of Three-Dimensional Polyurethane Composites Reinforced with Warp-Knitted Spacer Fabrics
Authors: Lou Ge , Chen Si
Published: August 2022

In this study, a novel composite having a unique three-dimensional structure was investigated. Warp-knitted spacer fabrics with glass fiber woven fabric were chosen as the reinforcement, while polyurethane foam was used as the matrix materials. The glass fiber woven fabric was pretreated with the warp-knitted spacer fabric first, and then a hand lay-up method was used to fabricate the three-dimensional polyurethane-based composites. The mechanical properties of the finished composites were determined. The influence of the fabric thickness, the surface structure of the fabric, and whether the woven fabric is laminated or not on the mechanical properties of the three-dimensional polyurethane composites were determined. The results show that the fabric thickness is positively related to the tensile and compressive properties and inversely related to the bending properties of the three-dimensional knitted/woven hybrid polyurethane matrix composites, provided that the surface structure is the same. The tensile and compressive strengths of the composites were higher when the glass fiber woven fabric was laminated with the spacer fabric than when the three-dimensional knitted/woven hybrid polyurethane matrix composites were not taken. Therefore, the knitted/woven fabric as reinforcement improved the tensile and compressive properties of the composites.
Techniques in Otolaryngology: Ultrasound‐Guided Transcervical Fine‐Needle Aspiration of Laryngeal Masses
Authors: Quatela Olivia , Self Quinn , Herrington Heather , Brundage William , Silverman Damon , Sajisevi Mirabelle
Published: August 2022

Traditionally, laryngeal masses are diagnosed with direct laryngoscopy with biopsy under general anesthesia. The use of transcervical ultrasound–guided fine‐needle aspiration for the diagnosis of base of tongue lesions, thyroid nodules, and cervical lymph node metastases has been well documented, and its use in the diagnosis of laryngeal masses has increased in recent years. We report a technique for office‐based transcervical ultrasound–guided fine‐needle aspiration for laryngeal masses without cervical metastasis (N0), with outcomes from 6 patients. Benefits of this approach included limited side effects, rapid in‐office diagnosis, avoidance of aerosolizing procedures during the COVID‐19 pandemic, and avoidance of tracheostomy.
Minerals of the arctite supergroup from the Bellerberg volcano xenoliths, Germany
Authors: Juroszek Rafał , Krüger Biljana , Marciniak-Maliszewska Beata , Ternes Bernd
Published: August 2022

The recently defined arctite supergroup contains nine mineral members defined as hexagonal intercalated antiperovskites, most of which have been found in pyrometamorphic rocks of the Hatrurim Complex, Israel. Three members of this supergroup: nabimusaite, gazeevite and zadovite, were identified for the first time in altered carbonate–silicate xenoliths from the Caspar and Scherer quarries, Bellerberg volcano in Germany. Present work focuses on the chemical, structural and spectroscopic investigation of these minerals and their correlation with holotype counterparts. The apparent differences are mainly related to the chemical composition, types of substitution in the tetrahedral and antiperovskite layers within the crystal structure, and position of bands in the Raman spectra. In the Bellerberg volcano xenoliths, the crystallisation of nabimusaite and gazeevite is caused by high-temperature alteration of early mineral associations (clinker-like phases) and their reaction with melt or gas generated by volcanic activity. In turn, the formation of zadovite is related to the Ba-rich silicate melt that filled the intergranular space between the rock-forming minerals.
Iron-bearing to iron-rich tourmalines from granitic pegmatites of the Murzinka pluton, Central Urals, Russia
Authors: Gvozdenko Tatiana A. , Baksheev Ivan A. , Khanin Dmitry A. , Voronin Mikhail V. , Chervyakovskaya Maria V. , Smolensky Vadim V.
Published: August 2022

Black tourmalines from seven granitic pegmatites (Golodnaya, Kazennitsa, Mokrusha, Kopi Mora, Zheltyye Yamy, Buzheninov Bor and Ministerskaya) related to the Murzinka pluton, Central Urals, Russia have been investigated using electron microprobe analysis, LA-ICP-MS, Raman and Mössbauer spectroscopy. Pegmatites are hosted by serpentinites and gneisses and are classified as schorl, oxy-schorl, fluor-schorl, dravite, oxy-dravite, foitite, oxy-foitite and darrellhenryite. The possible compositional evolution of tourmalines from the Ural pegmatites is as follows: Mg-rich dravite through to Fe-rich schorl, foitite and oxy-foitite to Fe- and Mn-rich darrellhenryite. The major substitutions in the tourmalines are: (1) Fe2+ ↔ Mg; (2) Al + WO2– ↔ Fe2+ + WOH–; (3) X-site vacancy + Al ↔ Na + Fe2+; (4) Al + WO2– ↔ Mg + WOH–; (5) X-site vacancy + Al ↔ Na + Mg; and (6) Fe ↔ Mn. Statical processing of the trace- and major-element composition distinguished three tourmaline groups: (1) trace Co, Ni, Pb, and major Ca and Mg; (2) uni-, di- and trivalent traces (Li, Zn, Ga) and di- and trivalent majors (Al, Mn); (3) U, Th, Hf, Ta, Nb, Y, In, and Sn which correspond to tri-, tetra-, and pentavalent high-field-strength elements. Mössbauer data shows the Fe3+/Fe2+ ratios in tourmalines from pegmatites hosted by gneisses (0.05–0.18) and serpentinites (0.28–0.65), indicates different oxidising environments. Raman data are consistent with the composition of the tourmalines.
Loss of α4A- and β1-tubulins leads to severe platelet spherocytosis and strongly impairs hemostasis in mice
Authors: Kimmerlin Quentin , Moog Sylvie , Yakusheva Alexandra , Ziessel Catherine , Eckly Anita , Freund Monique , Závodszky Gábor , Knapp Yannick , Mangin Pierre , Lanza François
Published: August 2022

Native circulating blood platelets present with a discoid flat morphology maintained by a submembranous peripheral ring of microtubules, named marginal band. The functional importance of this particular shape is still debated, but it was initially hypothesized to facilitate platelet interaction with the injured vessel wall and to contribute to hemostasis. The importance of the platelet discoid morphology has since been questioned on the absence of clear bleeding tendency in mice lacking the platelet-specific β1-tubulin isotype, which exhibits platelets with a thinner marginal band and an ovoid shape. Here, we generated a mouse model inactivated for β1-tubulin and α4A-tubulin, an α-tubulin isotype strongly enriched in platelets. These mice present with fully spherical platelets completely devoid of a marginal band. In contrast to the single knockouts, the double deletion resulted in a severe bleeding defect in a tail-clipping assay, which was not corrected by increasing the platelet count to normal values by the thrombopoietin-analog romiplostim. In vivo, thrombus formation was almost abolished in a ferric chloride–injury model, with only a thin layer of loosely packed platelets, and mice were protected against death in a model of thromboembolism. In vitro, platelets adhered less efficiently and formed smaller-sized and loosely assembled aggregates when perfused over von Willebrand factor and collagen matrices. In conclusion, this study shows that blood platelets require 2 unique α- and β-tubulin isotypes to acquire their characteristic discoid morphology. Lack of these 2 isotypes has a deleterious effect on flow-dependent aggregate formation and stability, leading to a severe bleeding disorder.
Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study
Authors: Ratanachina Jate , Amaral Andre F.S. , De Matteis Sara , Lawin Herve , Mortimer Kevin , Obaseki Daniel O. , Harrabi Imed , Denguezli Meriam , Wouters Emiel F.M. , Janson Christer , Nielsen Rune , Gulsvik Amund , Cherkaski Hamid Hacene , Mejza Filip , Mahesh Padukudru Anand , Elsony Asma , Ahmed Rana , Tan Wan , Loh Li Cher , Rashid Abdul , Studnicka Michael , Nafees Asaad A. , Seemungal Terence , Aquart-Stewart Althea , Al Ghobain Mohammed , Zheng Jinping , Juvekar Sanjay , Salvi Sundeep , Jogi Rain , Mannino David , Gislason Thorarinn , Buist A. Sonia , Cullinan Paul , Burney Peter
Published: August 2022

Background

Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study.

Methods

We analysed cross-sectional data from 28 823 adults (≥40 years) in 34 countries. We considered 11 occupations and grouped them by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)/FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income.

Results

Overall, working in settings with potentially high exposure to dusts or fumes was associated with respiratory symptoms but not lung function differences. The most common occupation was farming. Compared to people not working in any of the 11 considered occupations, those who were farmers for ≥20 years were more likely to have chronic cough (OR 1.52, 95% CI 1.19–1.94), wheeze (OR 1.37, 95% CI 1.16–1.63) and dyspnoea (OR 1.83, 95% CI 1.53–2.20), but not lower FVC (β=0.02 L, 95% CI −0.02–0.06 L) or lower FEV1/FVC (β=0.04%, 95% CI −0.49–0.58%). Some findings differed by sex and gross national income.

Conclusion

At a population level, the occupational exposures considered in this study do not appear to be major determinants of differences in lung function, although they are associated with more respiratory symptoms. Because not all work settings were included in this study, respiratory surveillance should still be encouraged among high-risk dusty and fume job workers, especially in low- and middle-income countries.
A modified Delphi approach to determine current treatment advances for the development of a resuscitation program for maternal cardiac arrest
Authors: Shields Andrea D. , Battistelli Jacqueline D. , Kavanagh Laurie B. , Thomson Brook A. , Nielsen Peter E.
Published: August 2022

Objective

Maternal cardiac arrest is a rare and complex process requiring pregnancy-specific responses and techniques. The goals of this study were to (1) identify, evaluate, and determine the most current best practices to treat this patient population and (2) establish a standardized set of guidelines to serve as a foundation for a future educational simulation-based curriculum.

Study design

We used a three-step modified Delphi process to achieve consensus. Twenty-two healthcare experts from across North America agreed to participate in the expert panel. In round 1, 12 pregnancy-specific best practice statements were distributed to the expert panel. Panelists anonymously ranked these using a 7-point Likert scale and provided feedback. Round 2 consisted of a face-to-face consensus meeting where statements that had not already achieved consensus were discussed and then subsequently voted upon by the panelists.

Results

Through two rounds, we achieved consensus on nine evidence-based pregnancy-specific techniques to optimize response to maternal cardiac arrest. Round one resulted in one of the 12 best practice statements achieving consensus. Round two resulted in six of the remaining 12 gaining consensus. Best practice techniques involved use of point-of care ultrasound, resuscitative cesarean delivery, cardiopulmonary resuscitation techniques, and the use of extracorporeal cardiopulmonary resuscitation.

Conclusion

The results of this study provide the foundation to develop an optimal, long-term strategy to treat cardiac arrest in pregnancy. We propose these nine priorities for standard practice, curricula, and guidelines to treat maternal cardiac arrest and hope they serve as a foundation for a future educational curriculum.
PNPLA3 and TM6SF2 genetic variants and hepatic fibrosis and cirrhosis in Pakistani chronic hepatitis C patients: a genetic association study
Authors: Rauff Bisma , Alzahrani Badr , Chudhary Shafiq A. , Nasir Bilal , Mahmood Saqib , Bhinder Munir Ahmad , Faheem Muhammad , Amar Ali
Published: August 2022

Background

The present study investigates if common missense functional variants p.I148M and p.E167K in PNPLA3 and TM6SF2 genes, respectively, associate with development of hepatic fibrosis and cirrhosis in a geographically novel cohort of Pakistani chronic hepatitis C (CHC) patients.

Methods

In total, 502 Pakistani CHC patients [242 males, median age 40 years, 220 with significant hepatic fibrosis, including 114 with cirrhosis] were genotyped for PNPLA3 and TM6SF2 variants using TaqMan genotyping assays. Associations between genotypes, biochemical and clinical parameters were evaluated.

Results

Genotypic distributions for PNPLA3 and TM6SF2 polymorphisms conformed to Hardy–Weinberg equilibrium and did not associate with fibrosis grades ≥ F2 or cirrhosis in any of the genetic models tested (all p =  > 0.05). PNPLA3 and TM6SF2 variants did not modulate baseline characteristics and serum markers of liver injury in CHC patients. Similarly, increasing number of risk alleles of PNPLA3 and TM6SF2 polymorphisms had no trend effect on serum liver enzyme activities or proportion of CHC patients with significant or advanced fibrosis or cirrhosis (p =  > 0.05). The same trend of no association with hepatic fibrosis or cirrhosis persisted in the multivariate logistic regression models adjusting for age, gender, body mass index and HCV viral load (p =  > 0.05).

Conclusions

PNPLA3 and TM6SF2 variants do not appear to modulate development of hepatic fibrosis or cirrhosis in present CHC patients of Pakistani origin, and may be of more relevance in liver pathology involving abnormalities in hepatic fat accumulation. These results also reflect the divergent associations observed for different genetic modifiers of hepatic fibrosis and cirrhosis in distinct ethnicities.
Effect of skeletal muscle loss during neoadjuvant imatinib therapy on clinical outcomes in patients with locally advanced GIST
Authors: Ding Ping’an , Guo Honghai , He Xiaoxiao , Sun Chenyu , Lowe Scott , Bentley Rachel , Zhou Qin , Yang Peigang , Tian Yuan , Liu Yang , Yang Li , Zhao Qun
Published: August 2022

Background

Currently, the effect of skeletal muscle loss during neoadjuvant imatinib therapy on clinical outcomes in patients with locally advanced gastrointestinal stromal tumors (LA-GIST) remains unclear. This study aims to investigate the relationship between changes in skeletal muscle and postoperative complications, survival and tumor response in patients with LA-GIST during neoadjuvant therapy with imatinib.

Methods

We retrospectively analyzed pre- and post-treatment computed tomography images of 57 GIST patients who underwent radical surgery after neoadjuvant therapy with imatinib from January 2013 to March 2019. Skeletal muscle index (SMI) was measured at the L3 vertebral level in all patients. A cut-off value (SMI < 52.3 cm2/m2 and < 38.6 cm2/m2 for men and women, respectively) published in a previous study was used to define sarcopenia. Based on gender, we defined ΔSMI (%)/250 days above 9.69% for men and ΔSMI (%)/250 days above 7.63% for women as significant muscle loss (SML). Factors associated with postoperative complications and tumor response were analyzed using logistic regression, and predictors affecting patient prognosis were analyzed using Cox regression.

Results

Of the 57 patients, sarcopenia was present before and after neoadjuvant therapy in 20 (35.09%) and 28 (49.12%) patients, respectively. It was not associated with immediate or long-term clinical outcomes. However, patients with SML during neoadjuvant therapy had a higher incidence of postoperative complications (60.00% vs. 25.00%, p = 0.008), worse pathological regression (44.00% vs. 75.00%, p = 0.017) and worse 3-year survival (Male, 68.75% vs. 95.45%, p = 0.027; Female, 66.67% vs. 100.00%, p = 0.046) than patients without SML.

Conclusion

The development of SML during neoadjuvant therapy in LA-GIST patients, rather than pre- and post-treatment sarcopenia, is a major prognostic factor for the long-term prognosis and is also associated with recent postoperative complication rates and pathological regression.
Relationship between diet quality and depression among Iranian older adults in Tehran
Authors: Chegini Maedeh , Shirani Pedram , Omidvar Nasrin , Eini-Zinab Hassan , Pour-Ebrahim Fatemeh , Rezazadeh Arezoo
Published: August 2022

Background

Depression is one of the prevalent mental disorders that is common in older ages. Evidence suggests that dietary intake status may potentially be associated with depression. However, this association has not been well studied in older adults, and the nature of the association remains unclear. This study aimed to investigate the association between diet quality and depression in free-living older adults living in Tehran city.

Methods

This cross-sectional study was conducted on 583 older adults (279 men and 304 women) aged 60 to 80 years living in Tehran city, selected by the systematic cluster sampling method. Individuals' dietary intake was determined by two non-consecutive 24-h dietary recalls, and diet quality was assessed calculating score of Healthy Eating Index-2015 (HEI-2015). The validated short form of the Geriatric Depression Scale (GDS-11) was used to assess depression status. A logistic regression model was used to assess the chance of depression across tertiles of HEI-2015 score.

Results

The point prevalence of depression was 22.5%, which was significantly higher in women (91 (69.5%) women vs. 40 (30.5%) men). A higher percentage of seniors at the higher tertile of HEI score were women, belonged to Fars ethnicity and had a higher score of activity of daily living (ADL). After adjustment for all potential confounders, the trend of depression chance was significantly decreased in those with higher HEI-2015 scores (p-for trend < 0.05).

Conclusion

Higher quality of diet was associated with a lower possibility of depression in the studied participants. Further studies are required to investigate the possible causal relationship.
Loneliness, loneliness literacy, and change in loneliness during the COVID-19 pandemic among older adults: a cross-sectional study
Authors: Hsu Hui-Chuan , Chao Shiau-Fang
Published: August 2022

Background

Loneliness has become a significant public health concern for older people. However, little is known about the association of loneliness, loneliness literacy, and changes in loneliness during the COVID-19 pandemic with mental well-being. The purpose of this study was to explore whether loneliness literacy is related to a lower risk of loneliness, increased loneliness during the COVID-19 pandemic, and improved mental well-being for community-based older adults.

Methods

A telephone survey was conducted to collect data from older adults aged 65 years or older in Taiwan (n = 804). Loneliness, change in loneliness during COVID-19, and loneliness literacy were the main variables. Mental well-being was assessed by depressive symptoms and life satisfaction. Related factors included personal level (demographics, health conditions, health behaviors, and problem-focused/ emotion-focused coping strategies), interpersonal level (marital status, living arrangements, social support, social participation, leisure activities, and social interactions during COVID-19), and societal level (areas and regions) factors.

Results

Four dimensions of loneliness literacy were identified by factor analysis: self-efficacy, social support, socialization, and in-home support. Self-efficacy and in-home support were related to lower loneliness. Lower self-efficacy, higher social support, and higher socialization were related to changes (increases) in loneliness during COVID-19. In-home support may prevent depressive symptoms, while self-efficacy was beneficial for better life satisfaction. In addition, emotion-focused coping may increase loneliness during COVID-19, while satisfaction with family support would be a protective factor against loneliness.

Conclusion

Loneliness literacy is related to loneliness and increased loneliness during the COVID-19 pandemic. Building up an age-friendly community with embedded services/information and learning positive coping and mental resilience strategies are suggested.
Psychosocial and behavioral health indicators among immigrant and non-immigrant recent mothers
Authors: Ewesesan Roheema , Chartier Mariette J. , Nickel Nathan C. , Wall-Wieler Elizabeth , Urquia Marcelo L.
Published: August 2022

Background

Perinatal risk factors can vary by immigration status. We examined psychosocial and behavioral perinatal health indicators according to immigration status and immigrant characteristics.

Methods

We conducted a population-based cross-sectional study of 33,754 immigrant and 172,342 non-immigrant childbearing women residents in Manitoba, Canada, aged 15–55 years, who had a live birth and available data from the universal newborn screen completed within 2 weeks postpartum, between January 2000 and December 2017. Immigration characteristics were from the Canadian federal government immigration database. Logistic regressions models were used to obtain Odds Ratios (OR) with 95% confidence intervals (CI) for the associations between immigration characteristics and perinatal health indicators, such as social isolation, relationship distress, partner violence, depression, alcohol, smoking, substance use, and late initiation of prenatal care.

Results

More immigrant women reported being socially isolated (12.3%) than non-immigrants (3.0%) (Adjusted Odds Ratio (aOR): 6.95, 95% CI: 6.57 to 7.36) but exhibited lower odds of depression, relationship distress, partner violence, smoking, alcohol, substance use, and late initiation of prenatal care. In analyses restricted to immigrants, recent immigrants (< 5 years) had higher odds of being socially isolated (aOR: 9.04, 95% CI: 7.48 to 10.94) and late initiation of prenatal care (aOR: 1.50, 95% CI: 1.07 to 2.12) compared to long-term immigrants (10 years or more) but lower odds of relationship distress, depression, alcohol, smoking and substance use. Refugee status was positively associated with relationship distress, depression, and late initiation of prenatal care. Secondary immigrants, whose last country of permanent residence differed from their country of birth, had lower odds of social isolation, relationship distress, and smoking than primary migrants. There were also differences by maternal region of birth.

Conclusion

Immigrant childbearing women had a higher prevalence of social isolation but a lower prevalence of other psychosocial and behavioral perinatal health indicators than non-immigrants. Health care providers may consider the observed heterogeneity in risk to tailor care approaches for immigrant subgroups at higher risk, such as refugees, recent immigrants, and those from certain world regions.
Determinants of anemia status among pregnant women in ethiopia: using 2016 ethiopian demographic and health survey data; application of ordinal logistic regression models
Authors: Animut Kassahun , Berhanu Getasew
Published: August 2022

Background

Anemia is a serious public health problem that occurs when the blood contains fewer red blood cells than normal. In Ethiopia, the prevalence of anemia in pregnancy increased between 2005 and 2016. The aim of this study was to determine what factors influence the anemia status of pregnant women in Ethiopia.

Methods

Anemia status in a sample of 1053 pregnant women was studied using data from Ethiopia's Demographic and Health Survey 2016. Percentages and graphs were used to show the prevalence of anemia. The marginal probability effect was used to determine the contribution of each explanatory variable category to a single response category of anemia level. Ordinal logistic regression models were constructed, and the best-fitting model was selected to reveal significant anemia status variables.

Results

The prevalence of anemia in pregnant women was found to be 37.51% (3.04% severe, 17.28% moderate, and 17.1% mild anemic). The fitted partial proportional odds model revealed that anemia status of pregnant women was significantly associated with region afar (OR = 0.45; CI: 0.21–0.96), antenatal care visits above 4 (OR = 1.58; CI: 1.03–2.43), parity between 1–2 (OR = 0.47;CI: 0.26–0.85), iron taking (OR = 3.68;CI: 2.41–5.64), and higher education (OR = 4.75;CI: 2.29–9.85).

Conclusions

Anemia among pregnant women has been identified as a moderate public health issue in Ethiopia. The study revealed that the prevalence of anemia varied among regions which the highest (65.9%) and the lowest (9%) being from Somali and Addis Ababa, respectively. As a result, it is argued that treatments target iron consumption, maternal education, antenatal visits, and mothers' access to health care.
Financial risk of emergency abdominal surgery: a cross sectional study from Ethiopia
Authors: Genetu Abraham , Gezahegn Demmelash , Getachew Hana , Deneke Andualem , Bekele Abebe
Published: August 2022

Background

The Lancet Commission on Global Surgery suggested six indicators every country should use to measure their surgical systems. One of these indicators, catastrophic expenditure (CE), is defined as money paid for service which amounts to more than 10% of the patient’s total annual expenditure, or more than 40% of annual non-food household expenditure. Ethiopian Ministry of Health has set a target of 100% protection from CE by 2030. However, so far there is lack of studies that assess financial risk of surgery.

Methods

Using a cross sectional study design, financial risk assessment was carried out on 142 patients from Yekatit 12 and Zewditu Memorial hospitals in Addis Ababa, Ethiopia from May 15 to September 15, 2021.

Results

Appendectomy (69.0%), emergency laparotomy (26.1%) and cholecystectomy (4.9%) resulted in mean direct medical expenditures of 111.7USD, 200.70USD and 224.60USD, respectively. Medications and imaging accounted for 60.8 and 13.9% of total treatment cost. By applying the two definitions of catastrophic expenditure, 67.6 and 62.7% of patients sustained CE, respectively Overall rates of CE across procedures were 67.3 and 59.1% for appendectomy, 70.2 and 70.2% for laparotomy, 57.0 and 71.2% for cholecystectomy. Thirty-five (24.6%) patients had some form of insurance, with Community Based Health Insurance being the most common form (57%). Insured patients were less likely to sustain CE with both definitions (AOR 0.09, p = 0.002 and AOR 0.10, p = 0.006 respectively).

Conclusion and recommendations

Substantial proportion of patients undergoing emergency abdominal surgery sustain CE in Addis Ababa. Medications and imaging take major share of total cost mainly because patients have to acquire them from private set ups. Policy makers should work on availing medications and imaging in public hospitals as well as expand insurance and other forms of surgical care financing to protect patients from CE.
Disease burden in patients with acute hepatic porphyria: experience from the phase 3 ENVISION study
Authors: Wang Bruce , Ventura Paolo , Takase Kei-ichiro , Thapar Manish , Cassiman David , Kubisch Ilja , Liu Shangbin , Sweetser Marianne T. , Balwani Manisha
Published: August 2022

Background

Acute hepatic porphyria (AHP) is a family of four rare genetic diseases, each involving deficiency in a hepatic heme biosynthetic enzyme. Resultant overproduction of the neurotoxic intermediates δ-aminolevulinic acid (ALA) and porphobilinogen (PBG) leads to disabling acute neurovisceral attacks and progressive neuropathy. We evaluated the AHP disease burden in patients aged ≥ 12 years in a post hoc analysis of the Phase 3, randomized, double-blind, placebo-controlled ENVISION trial of givosiran (NCT03338816), an RNA interference (RNAi) therapeutic that targets the enzyme ALAS1 to decrease ALA and PBG production. We analyzed baseline AHP severity via chronic symptoms between attacks, comorbidities, concomitant medications, hemin-associated complications, and quality of life (QOL) and evaluated givosiran (2.5 mg/kg monthly) in patients with and without prior hemin prophylaxis on number and severity of attacks and pain scores during and between attacks.

Results

Participants (placebo, n = 46; givosiran, n = 48) included patients with low and high annualized attack rates (AARs; range 0–46). At baseline, patients reported chronic symptoms (52%), including nausea, fatigue, and pain; comorbidities, including neuropathy (38%) and psychiatric disorders (47%); concomitant medications, including chronic opioids (29%); hemin-associated complications (eg, iron overload); and poor QOL (low SF-12 and EuroQol visual analog scale scores). A linear relationship between time since diagnosis and AAR with placebo suggested worsening of disease over time without effective treatment. Givosiran reduced the number and severity of attacks, days with worst pain scores above baseline, and opioid use versus placebo.

Conclusions

Patients with AHP, regardless of annualized attack rates, have considerable disease burden that may partly be alleviated with givosiran.